DOI: 10.1111/pde.
14375
ORIGINAL ARTICLE
Cutaneous manifestations in pediatric oncology patients
Ezgi Özkur MD1  | Cansu Sert MD2 | İlknur Kıvanç Altunay MD1 |
Zeynep Yıldız Yıldırırmak MD3 | Dildar Bahar Genç MD3 | Sema Vural MD3 |
Yasemin Erdem MD1
1
Dermatology Department, Şişli Hamidiye
Etfal Training and Research Hospital,
University of Health Sciences, İstanbul,
Turkey
2 related to primary disease and treatments. Although these skin toxicities are well
Department of Pediatrics, Şişli Hamidiye
Etfal Training and Research Hospital,
University of Health Sciences, İstanbul,
Turkey
3
Department of Pediatric Hematology and
Oncology, Şişli Hamidiye Etfal Training and
Research Hospital, University of Health
Sciences, İstanbul, Turkey
Correspondence
Ezgi Özkur, MD, Dermatology Department,
Şişli Hamidiye Etfal Training and Research
Hospital, University of Health Sciences, Etfal
sok. Şişli İstanbul, İstanbul 34100, Turkey.
Email: ezgierdal@hotmail.com
Pediatric Dermatology. 2020;00:1–8. wileyonlinelibrary.com/journal/pde© 2020 Wiley Periodicals LLC.     1
Pediatric
Dermatology
Abstract
Background/Objectives: Oncology patients present with various skin manifestations
described in adults, studies of pediatric oncology patients are limited. The objective
of this study was to evaluate the cutaneous findings in pediatric oncology patients
receiving chemotherapy.
Methods: In this prospective cohort study conducted from December 2018 to March
2020, all pediatric oncology patients were examined and patients who had a der-
matologic finding at any point during their treatments were recorded. Dermatologic
examinations were performed by the same dermatologists, and biopsy and microbio-
logic tests were performed according to clinical need. Patients were grouped accord-
ing to their oncologic diagnoses and types of chemotherapies.
Results: A total of 80 patients with a mean age of 9.1 ± 5.0 years were included in the
study. Seventy-five (93.7%) of them developed a dermatologic manifestation during
the study period. Most of the patients had hematologic malignancies (n = 48, 60%).
Antimetabolites were the most frequently used class of chemotherapeutic agents.
Anagen effluvium was the most common dermatologic finding (61.3%, n = 49), fol-
lowed by inflammatory dermatoses (51.2%, n = 41, most commonly diaper dermatitis
in 33 patients), xerosis (35%, n = 28), and nail changes (20%, n = 16, most commonly
nail pigmentation in seven patients). Mucositis was seen in 13 (16.2%) patients. Five
patients (6.2%) had drug-induced cutaneous hyperpigmentation, and five (6.2%) had
toxic erythema of chemotherapy. The highest percentage of xerosis (45.4%) was
detected in patients using antitumor antibiotics, whereas inflammatory dermatoses
were observed more in patients using antimetabolites (48.6% of patients using anti-
metabolites), and pigmentation changes were more frequently detected in patients
using alkylating agents.
Conclusion: Identification, diagnosis, and treatment of these reactions are important
to dermatologists and oncologists so that appropriate management may be provided
to pediatric oncology patients.
KEYWORDS
adverse effect, cutaneous manifestation, dermatology, pediatric oncology, side effect
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2       Pediatric ÖZKUR et al.
Dermatology
1 |  I NTRO D U C TI O N TA B L E 1   Patient demographics and diagnosis

Mean ± SD (Min-Max)
Pediatric oncology patients can present with dermatologic man-
Age (years) 9.1 ± 5.0 (2-17)
ifestations related to both their primary malignancies and che-
n %
motherapeutic agents. In most cases, these manifestations are
associated with chemotherapeutic agents causing varied muco- Diagnosis

cutaneous adverse effects. Skin changes represent a diagnostic Acute lymphoblastic leukemia 29 36.3

challenge and also impact the physical and psychosocial health of Acute myeloid leukemia 8 10.0
patients. It is therefore essential for physicians to be familiar with T-cell lymphoma 1 1.3
the clinical presentation. Studies with pediatric oncology patients Neuroblastoma 6 7.5
are limited to case reports and small prospective studies.1,2 The Wilms' tumor 4 5.0
aim of the study was to evaluate dermatologic manifestations of Medulloblastoma 1 1.3
pediatric oncology patients and to determine the cutaneous find- Ewing sarcoma 7 8.8
ings according to the type of malignancy and chemotherapeutic
Rhabdomyosarcoma 4 5.0
agents.
Germinoma 1 1.3
Hodgkin's lymphoma 5 6.3
Non-rhabdoid soft tissue sarcoma 1 1.3
2 |  M E TH O DS
Burkitt's lymphoma 5 6.3

This prospective, cohort study was performed in a pediatric oncol- Hepatoblastoma 2 2.5

ogy department between December 2018 and March 2020 after Osteosarcoma 3 3.8

obtaining approval from the local Ethics Committee and written
informed consent from the parents. We included all children and
adolescents aged under 17 years with proven malignancy requiring
systemic chemotherapy. All patients gave a detailed medical history
and underwent physical and dermatologic examinations. Patients
with a history of dermatologic diseases (eg, psoriasis and atopic
dermatitis) prior to the diagnosis of their malignancy were excluded
from the study (n = 2).
Seventy-five patients (93.7%) developed a dermatologic mani-
festation during the study period and were examined by the same
dermatologists, with photography and records of chemotherapy reg-
imens. Relevant investigations, skin biopsy, and cultures were per-
formed to confirm the clinical diagnosis when indicated.
Data were analyzed using the IBM SPSS 15.0 for Windows
v.21.0. software package (IBM Corp., Armonk, NY). Descriptive sta-
tistics are given as numbers and percentages for categorical vari-
ables and as averages and standard deviations for numeric variables,
when appropriate. Categorical variables in the patient subgroups
were compared using chi-square (χ2) tests or Fisher's exact tests.
Variables of P < .05 were considered significant.
3 |   R E S U LT S
Patient demographics and oncologic diagnoses are presented in
Table 1. Among the 80 pediatric oncology patients who met the
inclusion criteria, there were 26 females (32.5%) and 54 males
(67.5%). The mean age of the patients was 9.1 ± 5.0 years. Most
of the patients had a hematologic malignancy (n = 48, 60%). The
most common oncologic diagnosis was acute lymphoblastic leu-
kemia (ALL) (36.3%), followed by acute myeloid leukemia (AML)
(10%).
Optic glioma 1 1.3
Ependymoma 2 2.5
Dermatologic findings according to oncologic diagnoses are
presented in Table 2. Anagen effluvium was the most common
dermatologic diagnosis (61.3%, n  =  49), which occurred most
frequently in patients with bone and soft tissue tumors (93.3%,
n = 14). Inflammatory dermatoses (51%, n = 41), xeroderma (35%,
n = 28), and nail changes (20%, n = 16) were frequently observed
dermatologic manifestations. The most common inflammatory
dermatosis was diaper dermatitis (41%), and the most common nail
disorder was nail pigmentation (n = 7). Thirteen (16.2%) patients
had mucositis, five (6.2%) patients had drug-induced cutaneous
hyperpigmentation, and five (6.2%) had toxic erythema of chemo-
therapy (TEC).
Table 3 shows the dermatologic signs according to the types
of chemotherapeutic agents. Xerosis (45.4%, n = 15) was encoun-
tered more commonly in patients using antitumor antibiotics.
Inflammatory dermatoses (eg, contact dermatitis, diaper derma-
titis, and seborrheic dermatitis) (48.6%, n  =  34) and mucositis
(19.4%, n = 7) were encountered more commonly with antimetab-
olites. Drug-induced hyperpigmentation (11.6%, n = 5) (Figure 1)
and nail pigmentation (13.9%, n = 6) were frequently detected in
patients using alkylating agents. Systemic candidiasis was seen
only in patients using antimetabolites (n  =  3) among the chemo-
therapy subclasses. Cutaneous herpetic infections (one with her-
pes zoster and two with cutaneous herpes simplex) were seen in
patients treated with vinca alkaloids (14.2%). The highest per-
centage of patients with hypertrichosis was detected in patients
treated with antimetabolites (6.9%, n = 5).
ÖZKUR et al. Pediatric       3|
Dermatology
TA B L E 2   Cutaneous manifestations in pediatric oncology patients according to oncologic diagnoses

Hematologic Solid organ Bone and soft tissue Central nervous

Total malignancies tumors tumors system tumors
(n = 80) (n = 48) (n = 6) (n = 15) (n = 11)

n % n % n % n % n %

Anagen effluvium 49 61.3 23 47.9 5 83.3 14 93.3 7 63.6

Xerosis 28 35 20 41.7 0 0.0 3 20.0 5 45.5
Inflammatory dermatoses 41 51.2 28 58.3 2 33.3 4 26.6 3 27.2
Contact dermatitis 1 1.2 1 2.1 0 0.0 0 0.0 0 0.0
Seborrheic dermatitis 8 10 5 10.4 2 33.3 1 6.7 0 0.0
Diaper dermatitis 33 41.2 30 62.5 1 16.7 1 6.7 1 9.1
Perioral dermatitis 1 1.2 1 2.1 0 0 0 0.0 0 0.0
Cutaneous viral infections 4 5 2 4.2 1 16.7 1 6.7 0 0.0
Cutaneous bacterial infections 3 3.7 1 2.1 0 0.0 2 13.3 0 0.0
Cutaneous fungal infections 3 3.7 2 4.2 0 0.0 0 0.0 1 9.1
Exanthematous (morbilliform) 3 3.7 2 4.2 0 0.0 0 0.0 1 9.1
drug eruption
Urticaria/Angioedema 1 1.2 1 2.1 0 0.0 0 0.0 0 0.0
Leukocytoclastic vasculitis 2 2.5 2 4.2 0 0.0 0 0.0 0 0.0
Drug-induced hyperpigmentation 5 6.2 2 4.2 0 0.0 2 13.3 1 9.1
Toxic erythema of chemotherapy 5 6.2 4 8.3 1 16.7 0 0.0 0 0.0
(TEC)
Nail changes 16 20 9 18.7 0 0.0 5 33.3 2 18.1
Beau lines/Onychomadesis 3 3.7 2 4.2 0 0.0 1 6.7 0 0.0
Transverse ridging of the nails 1 1.2 1 2.1 0 0.0 0 0.0 0 0.0
Nail fragility 3 3.7 2 4.2 0 0.0 1 6.7 0 0.0
Nail pigmentation 7 8.7 3 6.3 0 0.0 3 20.0 1 9.1
Paronychia 2 2.5 1 2.1 0 0.0 0 0.0 1 9.1
Trichomegaly/Hypertrichosis 5 6.2 3 6.3 0 0.0 0 0.0 1 9.1
Acne 2 2.5 2 4.2 0 0.0 0 0.0 0 0.0
Mucositis 13 16.2 9 18.8 0 0.0 2 13.3 2 18.2
Ecchymosis 1 1.2 1 2.1 0 0.0 0 0.0 0 0.0
Telangiectasia 5 6.2 3 6.3 0 0.0 1 6.7 1 9.1

4 | D I S CU S S I O N mechanism of alopecia is secondary to a fall in the mitotic activity

The spectrum of dermatologic manifestations from cancer and its
treatments has a significant impact on the physical and psychosocial
well-being of children, and possibly on clinical outcomes. Although
dermatologic toxicities from cancer treatments have been well
described in adults, there are very few studies on such effects in
children.1-3
1
Cardoze-Torres et al evaluated 65 children with leukemia and
lymphoma and reported the most frequently seen dermatoses (ob-
served in 49% of their cohort) as anagen effluvium, xerosis, and acral
hyperpigmentation. Similarly, we found anagen effluvium (61.3%)
and xerosis (35%) to be the most common cutaneous adverse effects,
but we also observed that inflammatory dermatoses (51%) and nail
changes (20%) were frequent. This mirrors the reported incidence
(64.3%) of alopecia in adults receiving cancer chemotherapy.4 The
of the matrix cells of the hair follicle due to cytotoxicity.5 It was re-
ported that paclitaxel, doxorubicin, cyclophosphamide, and 5-fluo-
rouracil could cause alopecia in more than 60% of patients.6 Anagen
effluvium may occur with any agent that disrupts the cell cycle of
rapidly dividing cells. We found the highest percentage of anagen
effluvium (74.4%) in patients treated with alkylating agents (cyclo-
phosphamide, cisplatin, ifosfamide, carboplatin, and temozolomide).
The incidence of anagen effluvium noted with different agents in our
study may be, in part, because pediatric patients receive different
chemotherapeutic regimens than adults.
It has been estimated that the incidence of diaper dermatitis is
as high as 50% in children treating with chemotherapy regimens for
malignancies.7 In line with this, diaper dermatitis was seen in 41%
of the patients (n = 33) in our cohort. Diagnosis is based on rashes
in the diaper area. Children receiving cancer chemotherapies are at
TA B L E 3   Frequency of cutaneous findings according to chemotherapeutic agents
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Vinca Systemic
4      

alkaloids Alkylating agents Antitumor antibiotics Antimetabolites corticosteroids Etoposide Asparaginase

(n = 36) (n = 43) (n = 33) (n = 72) n = 11) (n = 9) (n = 2)

n % n % n % n % n % n % n %

Hair changes 23 63.8 33 76.7 23 69.6 47 65.2 2 22.2 7 77.8 2 100

Anagen effluvium 21 58.3 32 74.4 21 63.6 42 58.3 2 22.2 7 77.7 2 100
Telogen effluvium 2 5.5 1 2.3 2 6.1 5 6.9 0 0 0 0 0 0
Pediatric

Xerosis 13 36.1 11 25.5 15 45.4 26 36.1 4 44.4 3 27.3 0 0

Inflammatory dermatoses 5 13.8 7 16.2 1 3.03 36 50 3 27.2 2 18.2 0 0
Dermatology

Contact dermatitis 0 0 0 0 0 0 1 1.3 0 0 0 0 0 0

Seborrheic dermatitis 0 0 0 0 0 0 7 9.7 1 11.1 0 0 0 0
Diaper dermatitis 5 13.8 7 16.2 1 3 27 37.5 2 22.2 2 18.2 0 0
Perioral dermatitis 0 0 0 0 0 0 1 1.3 0 0 0 0 0 0
Cutaneous infections 5 13.8 4 9.3 4 12.1 14 19.4 0 0 1 9.1 0 0
Herpetic cutaneous 2 5.5 1 2.3 0 0 0 0 0 0 0 0 0 0
infections
Herpes zoster 1 2.7 0 0 1 3.0 0 0 0 0 0 0 0 0
Wart 1 2.7 2 4.6 1 3.0 7 9.7 0 0 1 9.1 0 0
Folliculitis 0 0 0 0 0 0 7 9.7 0 0 0 0 0 0
Furunculosis 1 2.7 0 0 1 3.0 0 0 0 0 0 0 0 0
Cellulitis 0 0 1 2.3 1 3.0 0 0 0 0 0 0 0 0
Mucocutaneous candidiasis 0 0 0 0 0 0 7 9.7 0 0 0 0 0 0
Systemic candidiasis 0 0 0 0 0 0 3 4.1 1 11.1 0 0 0 0
Drug-induced 3 8.3 5 11.6 3 9 1 1.3 1 11.1 0 0 1 50
hyperpigmentation
Exanthematous (morbilliform) 1 2.7 2 4.6 1 3.0 3 4.1 0 0 2 18.2 0 0
drug eruption
Urticaria/Angioedema 1 2.7 0 0 0 0 0 0 0 0 0 0 0 0
Leukocytoclastic vasculitis 0 0 1 2.3 0 0 1 1.3 0 0 0 0 0 0
Toxic erythema of 0 0 0 0 2 6.1 2 2.7 0 0 1 9.1 0 0
chemotherapy (TEC)
Nail changes 10 27 11 25.5 3 9.1 19 26.3 3 27.2 4 44.4 0 0
Beau lines/Onychomadesis 2 5.5 1 2.3 1 3.0 2 2.7 2 22.2 1 9.1 0 0
Transverse ridging of the nails 0 0 1 2.3 0 0 7 9.7 0 0 0 0 0 0
ÖZKUR et al.

(Continues)
 ÖZKUR et al.

TA B L E 3   (Continued)

Vinca Systemic
alkaloids Alkylating agents Antitumor antibiotics Antimetabolites corticosteroids Etoposide Asparaginase
(n = 36) (n = 43) (n = 33) (n = 72) n = 11) (n = 9) (n = 2)

n % n % n % n % n % n % n %

Nail fragility 2 5.5 2 4.6 1 3.0 4 5.5 0 0 1 9.1 0 0

Nail pigmentation 5 13.8 6 13.9 1 3.0 6 8.3 1 11.1 2 18.2 0 0
Paronychia 1 2.7 1 2.3 0 0 1 1.3 0 0 1 9.1 0 0
Trichomegaly/Hypertrichosis 2 5.5 2 4.6 0 0 5 6.9 0 0 0 0 0 0
Acne 1 2.7 0 0 0 0 3 4.1 0 0 0 0 0 0
Miliaria 1 2.7 1 2.3 0 0 0 0 0 0 1 9.1 0 0
Keratosis pilaris 3 8.3 0 0 0 0 2 2.7 0 0 0 0 0 0
Gingivitis 1 2.7 0 0 0 0 1 1.3 0 0 1 9.1 0 0
Mucositis 7 19.4 7 16.2 5 15.1 14 19.4 1 11.1 2 18.2 0 0
Ecchymosis 0 0 2 4.6 0 0 7 9.7 1 11.1 0 0 0 0
Telangiectasia 3 8.3 1 2.3 2 6.1 3 4.1 0 0 1 9.1 0 0
Other a  1 2.7 5 11.6 0 0 7 9.7 3 27.2 3 27.3 1 50

Note: Vinca alkaloids: vincristine, vinblastine, and paclitaxel. Alkylating agents: cyclophosphamide, cisplatin, ifosfamide, carboplatin, and temozolomide. Antitumor antibiotics: bleomycin, dactinomycin,
daunorubicin, idarubicin, epirubicin, and adriamycin. Antimetabolites: cytarabine, methotrexate, mercaptopurine, thioguanine, gemcitabine, and fludarabine. Without subclass: asparaginase and
etoposide.
a
Balanitis, postinflammatory hyperpigmentation at injection sites, striae, and moonface.
Pediatric
Dermatology
|      5
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6       Pediatric
Dermatology
F I G U R E 1   Mild hyperpigmentation of the axilla in a 5-y-old
female patient with Burkitt's lymphoma using ifosfamide,
cytarabine, methylprednisolone, and methotrexate. The neck and
periumbilical areas were also involved (not shown). The lesions
resolved 3 mo after cessation of chemotherapy
a far greater risk for diaper dermatitis due to factors such as uri-
nary excretion of the toxic metabolites of drugs and increased bowel
movements due to treatment-associated diarrhea. We found the
highest percentage of diaper dermatitis (37.5%) in patients treated
with antimetabolites. The mean age was 5.8 years in patients treated
with antimetabolites, which was younger than the mean age of the
cohort (9.1 years).
Our cohort exhibited a lower incidence (16.2%) of mucositis
and higher incidence of xerosis (35%) among pediatric oncol-
ogy patients than the reported incidence of mucositis (20%-
8 9
40%) and xerosis (4.4%) among adult oncology patients in the
literature.
Hyperpigmentation is a common adverse effect reported in
oncology patients, observed in the skin, mucosa, and nails. In
previous reports, hyperpigmentation was mostly secondary to
(A) (B) (C)
ÖZKUR et al.
alkylating agents in adult patients.10 Accordingly, we found that
drug-induced hyperpigmentation (11.6%) and nail pigmentation
(13.9%) were frequently detected in patients who were treated
with alkylating agents. Cyclophosphamide, hydroxyurea, pro-
carbazine, and busulfan have be found to be associated with a
generalized increase in pigmentation.11 Also, hyperpigmentation
from ifosfamide often occurs in the flexural areas (Figure  1).12
The mechanism is postulated to involve melanocyte stimulation
or postinflammatory hyperpigmentation.11 The most important
differential diagnosis of flexural hyperpigmentation among chil-
dren receiving cancer chemotherapies includes TEC. In our study,
we observed five patients with TEC. Bolognia et al13 proposed the
term TEC to discriminate the intertriginous pattern of toxic ery-
thematous drug reaction of chemotherapy. The clinical charac-
teristics of TEC are erythematous patches or edematous plaques
of the intertriginous zones, which are associated with symptoms
of pain, burning, paresthesias, pruritus, and tenderness; de-
velopment of a dusky hue, petechiae and erosions in some pa-
tients; and spontaneous resolution without specific therapy. The
presumed pathophysiology of TEC is the excretion of cytotoxic
agents into eccrine sweat ducts, resulting in localized toxic ef-
fects. It is most commonly associated with anthracyclines, cytar-
abine (Figures 2 and 3), and other antimetabolites.13 TEC presents
2 days to 3 weeks after drug administration. In contrast, drug-in-
duced flexural hyperpigmentation often presents after weeks of
therapy, fading within 6 to 12 months after discontinuation, with-
out preceding demarcated erythematous patches. TEC has a risk
of recurrence if the same chemotherapy agent is administered.
Prevention of recurrence involves a reduction of the current dose,
lengthening the interval between chemotherapy cycles, or cessa-
tion of the offending drugs. Other differential diagnosis consid-
erations for flexural dermatoses include allergic drug eruptions,
contact dermatitis, graft versus host disease, vasculitis, or cuta-
neous infections.
Cardoze-Torres et al1 reported that nail manifestations oc-
curred with a frequency of 15.6% in pediatric oncology patients,
and we found a similar rate of 20% including hyperpigmenta-
tion, fragility, onychomadesis, Beau's lines, and paronychia. Nail
pigmentation (8.8%) was the most frequently seen nail disorder.
Glibar et al reported that taxanes and anthracyclines were the
F I G U R E 2   Toxic erythema of
chemotherapy in a 2-y-old male patient
with acute myeloid leukemia, treated with
cytarabine, idarubicin, and etaposide.
The eruption affected skin folds and
chemotherapy was ceased. The patient
was treated with a 2-wk course of 0.5 mg/
kg systemic corticosteroid, topical
antibiotics, and zinc oxide ointment. The
lesion resolved completely in a month, and
offending agents were interrupted
ÖZKUR et al.
F I G U R E 3   Toxic erythema of chemotherapy in an 11-y-old
patient with Burkitt's lymphoma, undergoing treatment with
cyclophosphamide, methotrexate, cytarabine, methylprednisolone,
etoposide, vincristine, and ifosfamide. The lesion was located in
the intergluteal fold. The chemotherapy regimen was not stopped,
and the patient was treated with topical antibiotics, topical
corticosteroids, and zinc oxide ointment
antineoplastic drug groups most commonly responsible for nail
changes.14 Zawar et al15 found that the most common nail changes
were chromonychia (54.3%), followed by nail dystrophies (29.5%).
Chromonychia signifies an abnormality in the nail plate color,
thought to be associated with activation of matrix melanocytes.
(A)
F I G U R E 4   Candida septicemia in a
3-y-old girl with acute myeloid leukemia
treated with methotrexate, cytarabine,
and fludarabine. Skin biopsy showed
thrombi in small vessels and perivascular
inflammatory infiltrates with yeast.
Systemic anti-mycotic treatment was
administered
Pediatric |
      7
Dermatology
Zawar et al15 reported that most of the patients with chromon-
ychia received cyclophosphamide-containing chemotherapies,
occurring most frequently during the 2nd to 4th cycle of chemo-
therapy. We also found that alkylating agents including cyclophos-
phamide, cisplatin, ifosfamide, carboplatin, and temozolomide
(27.9%) were the most responsible agents, followed by antimetab-
olites (26.3%). We could not definitively pinpoint the culprit agent
due to the slow growth rate of the nail plate and involvement of
multi-drug chemotherapy regimens.
Ten patients had infectious manifestations, mostly cutaneous
bacterial and herpetic infections; none were life-threatening, nor
were they associated with significant morbidity. Five of these
patients were diagnosed as having hematologic malignancies.
Interestingly, systemic candidiasis was only seen in patients who
were using antimetabolites for cancer chemotherapy (n = 3). The
main risk factors for systemic candidiasis are host defense impair-
ment due to chemotherapy as well as the underlying hematologic
disease.16 Bae et al17 reported that the prevalence of systemic
candidiasis-associated skin lesions was 35.8%. The cutaneous
features of systemic candidiasis include a maculopapular or nod-
ular skin eruption at the onset of fungaemia (Figure  4), and skin
biopsy can demonstrate small aggregates of hyphae and spores
within the dermis.
There are some limitations to our study. It is nonrandomized, and
most patients were using multiple chemotherapeutic agents, which
prevented us from definitively pinpointing the culprit agent. Also,
re-challenge is not feasible in most patients. Studies of dermatologic
findings in pediatric oncology patients are limited. These manifes-
tations may display features distinct from those in adults. Herein,
we reported a wide range of dermatologic findings in 80 pediatric
oncology patients. It is important to diagnose and treat these man-
ifestations to improve the quality of life of patients, and positively
influence treatment outcomes by avoiding unnecessary dose and
drug modifications.
(B)
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8       Pediatric
Dermatology
ORCID
Ezgi Özkur  https://orcid.org/0000-0002-9136-7021
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