title: Generalized benign cutaneous reaction to cytarabine.
abstract: BACKGROUND
  Cytarabine-induced toxicity manifests as various cutaneous morphologies. A generalized papular purpuric eruption has not been well described.
  
  
  OBJECTIVE
  We aimed to characterize a distinct cytarabine-related eruption.
  
  
  METHODS
  We reviewed all cases of cytarabine-related toxicity with papular purpuric eruptions or violaceous erythema at the University of California, San Francisco between 2006 and 2011.
  
  
  RESULTS
  Sixteen cases were identified. The eruption began as erythematous papules that evolved into coalescing purpuric papules and plaques. It had affinity for intertriginous areas, neck, ears, and scalp. Pruritus was common, but no systemic complications were documented. Thirteen patients (81.3%) developed the eruption after completion of chemotherapy. Differential diagnosis often included viral exanthem (62.5%), drug eruption (50%), and vasculitis (37.5%). Histopathology was nonspecific but commonly demonstrated sparse lymphocytic infiltrates, spongiosis, and/or red cell extravasation. Importantly, the eruption was neither predicted by past cytarabine exposure nor predictive of future recurrence.
  
  
  CONCLUSIONS
  This is a review of cases from a single institution. Observation was limited to acute hospitalization, however, charts were reviewed for subsequent reactions on rechallenge.
  
  
  CONCLUSIONS
  The eruption described herein represents a specific skin-limited reaction to cytarabine. Awareness of its characteristic morphology, distribution, and timeline will aid in clinical diagnosis. Reassurance concerning its benign nature will prevent unnecessary intervention or cessation of chemotherapy.
authors: Department of Dermatology, University of California, San Francisco, San Francisco, California; Department of Pathology, University of California, San Francisco, San Francisco, California.
authors: Beth S
authors: BS
authors: Ruben
authors: School of Medicine, University of California, San Francisco, San Francisco, California.
authors: Wesley Y
authors: WY
authors: Yu
authors: Division of Dermatology, University of Washington, Seattle, Washington.
authors: Fan
authors: F
authors: Liu
authors: Department of Dermatology, Long Beach Veterans Affairs Medical Center, Long Beach, California.
authors: Sam V
authors: SV
authors: Truong
authors: Department of Dermatology, Stanford University, Stanford, California.
authors: Kevin C
authors: KC
authors: Wang
authors: Department of Dermatology, University of California, San Francisco, San Francisco, California. Electronic address: foxli@derm.ucsf.edu.
authors: Lindy P
authors: LP
authors: Fox
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D003561:Cytarabine / Q000009:adverse effects*; D003937:Diagnosis, Differential; D003875:Drug Eruptions / Q000209:etiology / Q000473:pathology*; D004890:Erythema / Q000139:chemically induced; D005076:Exanthema / Q000175:diagnosis / Q000821:virology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011537:Pruritus / Q000139:chemically induced; D011693:Purpura / Q000139:chemically induced; D017445:Skin Diseases, Vascular / Q000175:diagnosis; D014657:Vasculitis / Q000175:diagnosis; D055815:Young Adult
chemical_list: D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine
keywords: cytarabine; dermatopathology; drug reactions; pathophysiology; toxic erythema of chemotherapy