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Figure 2A : Violaceous patches on upper chest and dorsal hands .
Docetaxel is known to cause a variety of other periocular and eyelid manifestations . Cetinkaya et al described three patients on docetaxel with varying degrees of periorbital and eyelid marginal inflammation , madarosis ( loss of eyelashes ), inflammation and subsequent dysfunction of Meibomian glands , and cicatricial ( scarring ) changes of the eyelid skin or conjunctiva leading to marginal entropion ( in-turning of the eyelid ).[ 5 ] Kaya et al described cicatricial ectropion ( out-turning of the eyelid ) and periocular erythema in a patient treated with docetaxel for small-cell lung cancer .[ 6 ] All of these eyelid changes can ultimately cause worsening of epiphora and lead to exposure keratopathy due to poor apposition of the tensely-scarred eyelids . The differential diagnosis of periocular erythema and rash and / or cicatricial changes includes immunologically-mediated conditions such as allergic contact dermatitis , atopic dermatitis , and ocular rosacea ; inflammatory conditions such as drug-induced dermatomyositis , sarcoidosis , systemic sclerosis , lupus , or inflammatory dermatoses ; or neoplastic etiologies such as paraneoplastic dermatomyositis and cutaneous T-cell lymphoma .
This patient was managed with frequent artificial tears and artificial tear gel for dry-eye symptoms and was treated with desonide 0.05 % cream applied periocular twice a day , resulting in marked improvement of her periocular inflammation within 24 hours .
Our case underscores the importance of taking a comprehensive medication history and having a high index of suspicion for chemotherapy effect . There is expected improvement of symptoms within several weeks of cessation of the chemotherapy agent ; however , but with docetaxel , one should be aware of the potential for irreversible stenosis of the nasolacrimal system and ensure early evaluation and surveillance by an ophthalmologist for appropriate treatment .
Booser D . Canalicular stenosis secondary to docetaxel ( Taxotere ). A newly recognized side effect Ophthalmology 2001 ; 108:994 – 5 . ExternalResolverBasic Bibliographic Links Document Delivery Library Holdings [ Context Link ]
3 . Esmaeli B , Hortobagyi GN , Esteva FJ , et al . Canalicular stenosis secondary to weekly versus every- 3-week docetaxel in patients with metastatic breast cancer . Ophthalmology 2002 ; 109:1188 – 91 .
For a complete list of references , email ams @ arkmed . org .

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Figure 2B : Violaceous patches on dorsal feet .
References
1 . Valero V , Holmes F , Walters R , et al . Phase II trial of docetaxel : a new , highly effective antineoplastic agent in the management of patients with anthracycline-resistant metastatic breast cancer . J Clin Oncol 1995 ; 13:2886 – 94 .
2 . Esmaeli B , Valero V , Ahmadi MA ,
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