the method of the invention was evaluated in patients who developed ppes during pegylated liposomal doxorubicin therapy . discussed below are case reports of the first two patients treated with topical dmso for ppes caused by pegylated liposomal doxorubicin . as shown below , positive results were obtained from topical 99 % dmso ( containing 1 % water ) applied to the palms and soles in two patients who developed grade 3 ppes while on pegylated liposomal doxorubicin . contrary to other studies that suggest the efficacy of pyridoxine in the resolution of ppes in patients treated with fluorouracil , no protection was evident in these two patients , who developed grade 3 ppes while taking prophylactic pyridoxine therapy . other concentrations of dmso are also expected to be effective . preferably , a solution containing about 50 % to 100 % can be used . dmso may also be effective when mixed with other solvents , such as ethanol , acetone , or ether . in addition , a sustained release formulation of dmso could be developed , according to techniques known to those skilled in the art , and a sustained release formulation of dmso could be effective in treating ppes and more convenient to use than a dmso - water solution . despite the successful prior use of dmso to treat doxorubicin - induced extravasation injuries , dmso has not previously been used to treat ppes , and the successful use of dmso to treat ppes is surprising , due to the differences between extravasation injuries and ppes . for liposomal - doxorubicin - induced ppes , the applicants believe that the ppes may result from the release of small amounts of doxorubicin from liposomes that lodge and rupture in microcapillaries ( with standing and grasping pressure ), releasing doxorubicin into the subcutaneous tissue of the palms and soles . dmso may be effective in treating liposomal - doxorubicin - induced ppes because the dmso may transport the free doxorubicin into the systemic circulation and / or act as an antioxidant , thereby preventing doxorubicin &# 39 ; s toxic effects on the local soft tissues . dmso is also expected to be effective in treating ppes caused by other cancer drugs , such as capecitabine , fluorouracil , cytarabine , or non - liposomal doxorubicin . the following examples are presented for purposes of illustration and should not be construed as limiting the invention which is delineated in the claims . a 47 - year old mexican female with metastatic leiomyosarcoma to the lung was undergoing treatment at the arizona cancer center with pegylated liposomal doxorubicin at 50 mg / m 2 infused over 1 hour every four weeks . the patient subsequently developed grade 1 palmar - plantar erythrodysethesia with swelling and light discoloration of hands and feet ( without evidence of desquamation ) prior to administration of the third course of chemotherapy . despite the use of pyridoxine , 50 mg t . i . d . ( three times daily ), during the four weeks following her third treatment cycle , ppes increased in severity to grade 3 with swelling , erythema , pain and mild desquamation on her hands , as well as blisters on the dorsal aspects of the toes and the left anterior aspect of the wrist . she was seen in the arizona cancer center , at the time of the scheduled fourth treatment , and was instructed to apply 99 % dmso ( burdick & amp ; jackson div ., baxter healthcare , muskegon , mich . ; hplc - grade ) four times daily to the affected areas , delaying her fourth treatment cycle for one week . one week later , the patient was found to be without ulcers or blisters ; however , mild skin desquamation remained on her hands and fingers . pegylated liposomal doxorubicin therapy was continued at 50 mg / m 2 every four weeks for two additional four - week cycles . the signs and symptoms of ppes completely resolved by the time of the fifth course of pegylated liposomal doxorubicin while continuing topical 99 % dmso treatment . a 66 - year old white male with a history of metastatic melanoma ( lymph node , skin and lung metastases ) received the first cycle of pegylated liposomal doxorubicin , 50 mg / m 2 every four weeks plus pyridoxine 50 mg p . o . ( orally ) t . i . d . a second cycle was administered without incident . at the time of the third cycle of chemotherapy , the patient reported a rash , lasting approximately one week , on his back , arms and groin , associated with erythema and mild pruritis without desquamation ( i . e ., grade 1 skin toxicity ). when he returned to the arizona cancer center for his fourth therapy cycle , he had a severe rash on his buttocks , hands and feet and was unable to walk , because of grade 3 ppes , with skin edema , erythema , blistering and desquamation on his soles . pegylated liposomal doxorubicin therapy was held , pending resolution of the severe ppes , and the patient was instructed to apply topical 99 % dmso q . i . d . ( four times daily ) to his palms and soles . at his next clinic visit nine days later , there was resolution of sole edema allowing him to walk and skin erythema and desquamation was improved to grade 1 - 2 in severity . although pegylated liposomal doxorubicin therapy was not readministered , at patient &# 39 ; s request , due to fatigue , topical dmso therapy was continued . three weeks later , there was almost complete resolution of the ppes .
a method for treating palmar - plantar erythrodysethesia syndrome includes applying to affected areas a therapeutically effective amount of a dimethyl sulfoxide solution .