A 49-year-old man electively chose to undergo a trial of intravenous
chemotherapy with
5-fluorouracil (5-FU) for his inherited punctate
palmoplantar keratoderma (PPK). His father also had this skin disorder, which coincidentally cleared after 2 courses of
chemotherapy consisting of
5-FU and
cisplatin to treat his
lung cancer, prompting the patient to undergo this trial of
therapy. After the patient's first course of a 5-day continuous infusion (CI) of
5-FU (1000 mg/m2 per day), the lesions on his hands and feet regressed by approximately 80%. However, after completion of each course, the lesions seemed to reappear to some degree. The patient desired to pursue further
therapy; therefore, CI
5-FU at a dose of 250 mg/m2 per day (500 mg/d) was instituted, while
pyridoxine was avoided in the hope of causing a
hand-foot syndrome that may provide some long-term benefit. After receiving a 12-week course of
therapy of CI
5-FU at 250 mg/m2 per day, his lesions were approximately 95% improved, with only a few minute punctate
keratoses remaining. At follow-up nearly 4 years later, the lesions remain 90% cleared.