Guidelines for Complications of Cancer Treatment Vol VIII Part B

dependent, occurring from 8 days to 15 years after radiationtherapy. The shorter the time interval the more severe thereaction is. The higher doses of the initial radiation may playa role as well. The mechanism of action is not clear but theoriesimplicate both microvasculature effects, stem cell damage withdefective repair mechanisms, and impaired cutaneousimmunologic action 9Hyperpigmentation and Nail ChangeHyperpigmentation of the skin and nails and nail changes arevery common with chemotherapeutic drugs. The commondrugs causing these changes are arsenic trioxide, bleomycin,cisplatin, flurouracil, methotrexate and hydroxyurea. Hairchanges may also occur with regrowth. Many theories havebeen suggested, including a direct toxic effect on melanocytes,increased drug presence due to vascular changes, and increasedtoxicity of the skin secondary to eccrine gland drug secretion.Increased levels of adrenocorticotropic hormone (ACTH) andmelanocyte stimulating hormone (MSH) and drug-induceddepletion of tyrosinase inhibitors have been suggested aspotential factors 9 Postinflammatory hyperpigmentation froma variety of cutaneous eruptions is also seen.1. M Perry, The Chemotherapy Source Book,4 edi 2008136-1422. Roudier-Pujol C, Jan V. Drug-induced alopecia[Review]. Ann Dermatol Venereol 2000; 127(Suppl1):S26-S283. Randall J, Ream E. Hair loss with chemotherapy: at aloss over its management? Eur J Cancer Care (Engl)2005;14(3):223-2314. Extra JM, Rousseau F, Bruno R, et al. Phase I andpharmacokinetic study of Taxotere (RP 56976; NSC628503) given as a short intravenous infusion. CancerRes 1993; 53(5):1037-1042.475