Gemcitabine-associated acute lipodermatosclerosislike eruption: An underrecognized phenomenon

Gemcitabine is a commonly used chemotherapy for the treatment of various solid tumors as well as sarcomas and hematologic malignancies. Although side effects such as bone marrow suppression are well described, cutaneous side effects are less recognized. Certain gemcitabine-associated cutaneous reactions have been categorized under the umbrella terminology pseudocellulitis, including lipodermatosclerosislike and erysipeloid reactions, sclerodermalike changes, and radiation recall events.1, 2 Additionally, these reactions are often confused with other diagnoses, in particular, infectious cellulitis, which may subject patients to unnecessary treatment with antibiotics, hospitalizations, and interruption of chemotherapy. Given the widespread use of gemcitabine and the relatively few reported cases of associated acute lipodermatosclerosis (ALDS), we believe that the condition is underrecognized and underreported. We propose using a more specific diagnosis for cutaneous reactions to gemcitabine that will guide appropriate management. In this series, we report 4 cases of gemcitabine-associated ALDS-like eruptions and a literature review of 16 similar cases. To the best of our knowledge, this is the largest case series review reported for gemcitabine-associated ALDS-like eruptions.