Toxic Reaction to Prolonged High-Dose Fluorouracil

Robert H. Schosser, MD
JAMA. 1986;255(22):3116. doi:10.1001/jama.1986.03370220078019.
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To the Editor.—  Based on the information and photograph presented by Drs Feldman and Ajani1 in their PHOTO/ESSAY, I am unable to accept their conclusion that this represents a "toxic reaction to fluorouracil." A hyperkeratotic erythematous eruption involving the feet in a "moccasin distribution" and the palmar aspect of the hands is much more likely to be dermatophytosis or pityriasis rubra pilaris.No evidence was presented that would eliminate the possibility of a fungal etiology for these lesions. The biopsy results as stated do not rule out either dermatophytosis or pityriasis rubra pilaris.The photographed foot the authors present does not resemble bleomycin-associated Raynaud's phenomenon or the "peculiar acral erythema" described by Burgdorff et al.2


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