{'fraction_non_alphanumeric': 0.020384615384615383, 'fraction_numerical': 0.001153846153846154, 'mean_word_length': 5.89920424403183, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
A case of fixed drug eruption due to quinine

skin and nails, such as rash, alopecia, hand and foot syndrome, or nail abnormalities. Chemotherapeutic agents have rarely been implicated in acute paronychia. However, the disorder has been reported after high-doses of methotrexate and taxoids. Acute paronychia in our patient was attributed to the use of lapatinib, because of the close temporal association of the condition 2 months after starting the drug. The possible pathogenetic mechanisms might be associated with EGFR. EGFR plays a critical role within the epidermis, stimulating epidermal growth, inhibiting differentiation, protecting against ultraviolet-induced damage, inhibiting inflammation and accelerating wound healing. Drug-induced inhibition of EGFR is thought to alter keratinocyte proliferation, differentiation, migration and attachment. These changes might account for the appearance of periungual inflammation and bacterial overgrowth during EGFR inhibitor therapy. Capecitabine is an orally administered prodrug of fluorouracil. It is indicated for the treatment of patients with metastatic breast cancer failing anthracycline therapy, and as monotherapy for metastatic breast cancer resistant to paclitaxel and anthracycline. The most common adverse events occurring in patients receiving capecitabine monotherapy include lymphopenia, anaemia, diarrhoea, handand-foot syndrome, nausea, fatigue, hyperbilirubinaemia, dermatitis and vomiting. Nail abnormalities have only rarely been reported. These include PG-like lesions, onychomadesis and onycholysis, exudative hyponychial dermatitis. Although paronychia lesions have been reported after capecitabine treatment, our patient had started capecitabine 11 months before the appearance of the paronychia lesions. Even though a delayed reaction of capecitabine cannot be excluded, the long time interval suggests that lapatinib is the more likely causative agent. Lapatinib is a relatively new drug, and is in the investigational stages for inflammatory breast cancer, thus its sideeffects are not completely defined. However, during therapy with EGF inhibitors, nail changes such as paronychia or PG-like lesions have been reported. Although acute paronychia associated with lapatinib uptake has not been reported in the literature and should probably be considered an uncommon adverse event, the expanding role of combination chemotherapy with capecitabine and lapatinib for patients with advanced breast cancer suggests that its prevalence might increase in the future and oncologists and dermatologists should be aware of it.