RESUMO
A 25-year-old female patient presented with recurrent painful erythema and blisters on the palms and soles as well as in the axillary and inguinal regions for 1 month. Seven years ago, the patient underwent a small-incision sweat gland resection in the bilateral axillae for the treatment of axillary osmidrosis. One month ago, she underwent chemotherapy with pegylated liposomal doxorubicin (PLD) after surgery for stage-ⅡB cervical synovial sarcoma. During the 3 sessions of chemotherapy, she developed painful edematous erythema on the palms, soles, axillae and groins, which gradually worsened along with the increase in the number of chemotherapy sessions. Skin examination showed large areas of edematous erythema with clear boundaries at bilateral palms, soles, and intertriginous sites including axillae and groins, with millet- to soybean-sized blisters and erosions on the surface; the skin lesions showed relatively high temperature and positive Nikolsky's sign with obvious tenderness; there was no skin lesions or tenderness at the site of small-incision surgery for axillary osmidrosis in bilateral axillae. Histopathological examination of the axillary skin lesions showed formation of blisters under the basal layer and necrosis of some sweat glands. The diagnosis of PLD-associated intertrigo-like hand-foot syndrome was confirmed. The history of surgery for axillary osmidrosis and normal skin at the surgical site in this case suggest that the pathogenesis of this disease may be related to toxic skin reactions to the drug excreted through sweat glands.