Abstract：
OBJECTIVE: Scleroderma is a rare complication in taxanes therapy. Although individual cases of taxanes-induced scleroderma have been reported, the clinical manifestation and treatment outcomes were reviewed and summarized rarely. This study reported a patient who developed diffuse scleroderma and possible scleroderma renal crisis after paclitaxel therapy for ureter cancer.
METHODS: A PubMed literature review on published cases of taxanes-induced scleroderma up until April 2022 was included for analysis.
RESULTS: The search identified 27 patients with adequate information for analysis. Of the 28 patients, including the one presented here, 22 were female. Peripheral edema was the most common symptom in all but one patient, and often accompanied by erythema in 11. Symptoms usually occurred in half of the patients within the 4th course of treatment. Skin lesions gradually progressed to skin fibrosis, and extended proximally. Internal organ involvements were uncommon. Antinuclear antibody tests were positive occasionally, but anti-Scl70 and anti-centromere usually were negative. Taxanes therapy was discontinued, continued and unavailable in 21, 3, and 4 patients, respectively. Corticosteroids for skin lesions with or without immunosuppressive drugs were given to 15 patients. Of 25 patients with available skin outcomes, 19 improved. There was no significant skin improvement between those who did or did not receive skin treatment (62.5% vs. 75.0%, p = 0.37). Skin usually improved after discontinuing taxanes.
CONCLUSIONS: Taxanes-induced scleroderma is different from idiopathic scleroderma. Physicians should be aware of this condition in order to provide early diagnosis and apply appropriate management in order to avoid serious complications from severe skin sclerosis. Key Points • Scleroderma is a rare but unique and serious complication of taxanes therapy • Skin manifestations and distribution are similar to idiopathic scleroderma, but vascular phenomenon, internal organ involvement and scleroderma-associated auto-antibodies are presented rarely. Skin improvement usually occurs shortly after discontinuing taxanes • The role of immunosuppressive therapy in treating taxanes-induced scleroderma is not clear.
METHODS: A PubMed literature review on published cases of taxanes-induced scleroderma up until April 2022 was included for analysis.
RESULTS: The search identified 27 patients with adequate information for analysis. Of the 28 patients, including the one presented here, 22 were female. Peripheral edema was the most common symptom in all but one patient, and often accompanied by erythema in 11. Symptoms usually occurred in half of the patients within the 4th course of treatment. Skin lesions gradually progressed to skin fibrosis, and extended proximally. Internal organ involvements were uncommon. Antinuclear antibody tests were positive occasionally, but anti-Scl70 and anti-centromere usually were negative. Taxanes therapy was discontinued, continued and unavailable in 21, 3, and 4 patients, respectively. Corticosteroids for skin lesions with or without immunosuppressive drugs were given to 15 patients. Of 25 patients with available skin outcomes, 19 improved. There was no significant skin improvement between those who did or did not receive skin treatment (62.5% vs. 75.0%, p = 0.37). Skin usually improved after discontinuing taxanes.
CONCLUSIONS: Taxanes-induced scleroderma is different from idiopathic scleroderma. Physicians should be aware of this condition in order to provide early diagnosis and apply appropriate management in order to avoid serious complications from severe skin sclerosis. Key Points • Scleroderma is a rare but unique and serious complication of taxanes therapy • Skin manifestations and distribution are similar to idiopathic scleroderma, but vascular phenomenon, internal organ involvement and scleroderma-associated auto-antibodies are presented rarely. Skin improvement usually occurs shortly after discontinuing taxanes • The role of immunosuppressive therapy in treating taxanes-induced scleroderma is not clear.
摘要：
目的：硬皮病是紫杉烷类药物治疗中罕见的并发症。尽管紫杉烷类引起的硬皮病的个别病例已被报道，对临床表现和治疗结果进行回顾和总结很少。这项研究报道了一名患者在紫杉醇治疗输尿管癌后出现弥漫性硬皮病和可能的硬皮病肾危象。
方法：纳入了截至2022年4月发表的紫杉烷类引起的硬皮病病例的PubMed文献综述进行分析。
结果：搜索确定了27名具有足够分析信息的患者。在28名患者中，包括这里介绍的，22是女性除一名患者外，外周水肿是所有患者中最常见的症状，并常伴有红斑11.症状通常在第4个疗程内发生在一半的患者中。皮肤病变逐渐进展为皮肤纤维化，向近端延伸。内脏器官受累并不常见。有时抗核抗体检测呈阳性,但是抗Scl70和抗着丝粒通常是阴性的。紫杉类药物治疗停止，在21、3和4名患者中持续且不可用，分别。15例患者使用或不使用免疫抑制药物治疗皮肤病变的皮质类固醇。在25名具有皮肤预后的患者中，19改进接受或未接受皮肤治疗的患者之间皮肤无明显改善（62.5%vs.75.0%,p=0.37）。停止紫杉烷类后皮肤通常会改善。
结论：紫杉烷引起的硬皮病不同于特发性硬皮病。医生应该意识到这种情况，以便提供早期诊断并应用适当的管理，以避免严重皮肤硬化引起的严重并发症。•硬皮病是紫杉烷类治疗的一种罕见但独特且严重的并发症•皮肤表现和分布与特发性硬皮病相似,但是血管现象，内脏器官受累和硬皮病相关自身抗体很少出现。皮肤改善通常在停止紫杉烷类后不久发生•免疫抑制疗法在治疗紫杉烷类引起的硬皮病中的作用尚不清楚。
方法：纳入了截至2022年4月发表的紫杉烷类引起的硬皮病病例的PubMed文献综述进行分析。
结果：搜索确定了27名具有足够分析信息的患者。在28名患者中，包括这里介绍的，22是女性除一名患者外，外周水肿是所有患者中最常见的症状，并常伴有红斑11.症状通常在第4个疗程内发生在一半的患者中。皮肤病变逐渐进展为皮肤纤维化，向近端延伸。内脏器官受累并不常见。有时抗核抗体检测呈阳性,但是抗Scl70和抗着丝粒通常是阴性的。紫杉类药物治疗停止，在21、3和4名患者中持续且不可用，分别。15例患者使用或不使用免疫抑制药物治疗皮肤病变的皮质类固醇。在25名具有皮肤预后的患者中，19改进接受或未接受皮肤治疗的患者之间皮肤无明显改善（62.5%vs.75.0%,p=0.37）。停止紫杉烷类后皮肤通常会改善。
结论：紫杉烷引起的硬皮病不同于特发性硬皮病。医生应该意识到这种情况，以便提供早期诊断并应用适当的管理，以避免严重皮肤硬化引起的严重并发症。•硬皮病是紫杉烷类治疗的一种罕见但独特且严重的并发症•皮肤表现和分布与特发性硬皮病相似,但是血管现象，内脏器官受累和硬皮病相关自身抗体很少出现。皮肤改善通常在停止紫杉烷类后不久发生•免疫抑制疗法在治疗紫杉烷类引起的硬皮病中的作用尚不清楚。
