Generalised lichenoid drug eruption accompanied by hand-foot syndrome due to capecitabine

A 38-year-old female patient with breast cancer presented with itchy rash on the arms and feet and painful erythema on both palms and soles. She received oral capecitabine (Xeloda®) at a dose of 1250 mg/m2 twice daily for 14 days in 21-day cycles during the past 10 weeks. The lesions had been present for the past 6 weeks, and they first appeared 4 weeks after the initiation of capecitabine treatment. The patient had no other concurrent medication. There was no history of medication for any other illness in the recent past. The physical examination revealed well-defined erythema, oedema, and desquamation on the palmoplantar region. The diagnosis of hand-foot syndrome was made based on clinical features. She also had erythematous papules and plaques predominantly on the forearms and legs but also on her back and abdomen. The skin biopsy of a lesion on the dorsal aspect of the lower extremity revealed hyperkeratosis, irregular acanthosis with sawtooth pattern, spongiosis, eosinophils, and band-like lymphocytic infiltrate at the dermal-epidermal junction, interface dermatitis with vacuolar change in the basal layer, and apoptotic keratinocytes [Figure 2]c. Thus, the initial diagnosis of lichenoid drug eruption was confirmed by histopathology. Capecitabine therapy was stopped, and the patient was started on topical methylprednisolone and oral desloratadine 5 mg twice daily. In addition, two ampules each containing 6.43 mg betamethasone dipropionate and 2.63 mg betamethasone sodium phosphate were administered intramuscularly 15 days apart. The lesions healed completely after 5 weeks of the treatment.