Acral erythema in children receiving high-dose methotrexate.

Scant information is available concerning the occurrence and evolution of chemotherapy-induced acral erythema in children receiving intravenous high-dose methotrexate (MTX). Among 50 children with acute lymphoblastic leukemia or lymphoblastic lymphoma receiving a total of 203 courses of high-dose MTX (3-8 g/m2), 3 cases of acral erythema were observed. Painful erythema of finger and toe pads was noted in three children 3 days to 2 weeks after MTX infusion. The lesions resolved completely after blister formation and desquamation. These patients subsequently received high-dose MTX therapy without cutaneous problems. The present work points out that the chemotherapeutic schedule need not be modified in selected patients who develop acral erythema following high-dose MTX infusion.