Nonpharmacological treatment entails cooling of the affected regions and reduction in activity and friction in the affected areas. The treatment of toxic erythema of chemotherapy is symptomatic due to its benign course. Temperature of the body also seems to play a role in the pathological process as induced hypothermia of the affected regions often help reduce the symptoms and signs. It is postulated to result from a toxic effect of chemotherapy agents on eccrine cells and epidermis. The exact mechanism of ara-c ears is not well understood. However, in view of the clinical morphology and the classical drug etiology, the diagnosis of ara-c ears was made.
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In this case, our biopsy did not demonstrate the full histologic features of interface dermatitis as it was taken early on the first day of the rash. In typical cases, vacuolar interface dermatitis with necrotic keratinocytes is seen, with superficial dermal edema and perivascular lymphocytic infiltrate.
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When the diagnosis is not clear, a skin biopsy is done. The diagnosis of toxic erythema of chemotherapy is clinical. As the severity of signs and symptoms is dose-related, recurrence in post-remission chemotherapy tends to be more severe due to higher doses of drugs used as per the treatment protocol. There is a possibility of recurrence of the condition if a new cycle of chemotherapy is initiated. In severe cases, the skin may desquamate. Associated symptoms of pain, burning, paresthesia, pruritus and tenderness may be present. Notably, our patient had marked involvement of her ears. Rarely, it involves the ears, elbows and knees. It usually presents as erythematous patches or edematous plaques on the hands and feet as well as the intertriginous regions of the body. Toxic erythema of chemotherapy presents 2–12 days after initiation of chemotherapy and spontaneously resolves in a 1–2-week period. This reaction has been described most commonly in patients on cytarabine, pegylated liposomal doxorubicin, capecitabine or 5-fluorouracil. It is a rare subset of toxic erythema of chemotherapy, which is a well-established cutaneous side effect of chemotherapeutic agents. This is a classical case of ara-c ears where “ara-c” stands for the chemotherapeutic agent arabinosylcytosine, commonly known as cytarabine our patient was on this chemotherapeutic agent.Īra-c ears is a cutaneous toxicity caused by chemotherapeutic agents, most commonly cytarabine.