Doxorubicin toxicity. Onycholysis, plantar callus formation, and epidermolysis

DOXORUBICIN is now a well-established anticancer agent with significant activity against a large variety of solid tumors and hematologic malignancies. Its pharmacology is well described in two recent reviews.1,2The known toxic reactions are bone marrow suppression, stomatitis, alopecia, cardiotoxicity, and, more recently, melanotic changes in the palms, soles, and nail beds.3,4We report a case of dermatologic toxic reactions not previously described, to our knowledge. Report of a Case A 41-year-old white man was admitted on Aug 8,1974, because of soreness in both hands and feet, with loosening of all finger and toe nails (Figure). In July 1973, the patient underwent a shoulder disarticulation for fibrosarcoma of the right humerus. Postoperatively, he received 4,000 rads in combination with systemically given dactinomycin over a period of five weeks, with no toxic reactions. He was disease-free over the subsequent seven months, after which bilateral pulmonary metastases were detected on