Eosinophilic polymorphic and pruritic eruption associated with radiotherapy L92.2

Rueda et al. 1999

Rare, pruritic skin reaction with histoeosinophilia that may occur in the course of radiation therapy at the radiation site.

The etiopathogenesis of EPPER is unknown. It is likely to be a reactive radiation-induced cutaneous immune response that triggers a local cytokine cascade with consecutive eosinophilia. Of note, radiation-induced tumor-associated tissue eosinophilia has been described as a good prognostic sign in cervical cancer, postulating that tissue eosinophilia results from the formation or transformation of an antigen from the tumor as a result of radiation therapy, which triggers immune dysregulation in the host (Rueda R et al.1999).

Both inside and outside the irradiation field, itchy polymorphic, saturated red papules occur (see figure), some of which appear several weeks after the start of irradiation. Such "reactions" have been described after irradiation of breast and mammary carcinomas. In one case, this reaction occurred after irradiation of a Merkel cell carcinoma.

Dermal edema, dense dermal, perivascularly oriented eosinophilic infiltrate. Subepithelial blistering possible. No specific immunofluorescence phenomena.

Glucocorticoidsxterna.

1. Abdelrahman W et al (2018) Eosinophilic polymorphic and pruritic eruption associated with radiotherapy in a patient with primary nodal Merkel cell carcinoma. Int J Dermatol 57: 864-866.
2. García-Donoso C et al (2007) Eosinophilic, polymorphic and pruritic eruption associated with radiotherapy (EPPER) in two patients with breast tumour. J Eur Acad Dermatol Venereol 21:1102-1104.
3. Ghossein NA et al (1975) Radiation-related eosinophilia. Correlation with delayed hypersensitivity, lymphocyte count, and survival in patients treated by curative radiotherapy. Radiology 117:413-417.
4. Lee JE et al (2007) Eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy in a patient with breast cancer. J Am Acad Dermatol 56(2 Suppl):60-61.
5. Löbelenz L et al (2019) Eosinophilic polymorphic and pruritic eruption associated with radiotherapy: case report and overview of disease characteristics. Clin Exp Dermatol 44: 567-569.
6. Rueda R et al.(1999) Eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy. Arch Dermatol. 1999;135(7):804-810.