Paclitaxel-Related Lymphedema and Scleroderma-Like Skin Changes

Paclitaxel is an antimucrotubule agent used for the treatment of metastatic breast cancer. The development of scleroderma-like skin changes is an exceptional adverse effect. We report two patients with metastatic breast cancer treated by paclitaxel who presented an enexplained unilateral lymphedema of the upper limb. Medical work-up did not demonstrate any mechanical or tumor obstruction of the lymphatic vessels. Dermatologic examination revealed cutaneous and bucutaneous indurations and hardening of certain areas of the involved arm. The clinical suspicion of scleroderma was confirmed by histology and immunohistology. Treatment was initiated with methotrexate and methylprednisolone, resulting in a clear reduction of the lymphedema and a regression of the scleroderma. These two cases suggest a pathogenic role of paclitaxel-induced scleroderma in the subsequent development of severe localized lymphedema.