Acquired cutaneous adherence in patients with androgen-independent prostate cancer receiving ketoconazole and doxorubicin: Medication-induced sticky skin

Background: The phenomenon of sticky skin has been reported in patients with psoriasis who are receiving retinoids. Objective: We describe therapy-induced sticky skin in eight patients receiving ketoconazole and doxorubicin for androgen-independent prostate cancer. Methods: Patients were treated with oral daily ketoconazole (400 mg every 8 hours) and intravenous doxorubicin weekly (20 mg/m² continuously for 24 hours). Thirty-nine patients were entered into the study; retrospective information regarding sticky skin was obtainable from 28 patients or their spouses. Prostate specific antigen (PSA) values were compared in patients with and without therapy-induced sticky skin. Results: Eight patients (29%) described sticky skin. Six of these patients (75%) had a PSA response. Of the 20 patients without sticky skin a PSA response occurred in 12 (60%). Conclusion: Sticky skin occurred in patients with androgen-independent prostate cancer who were simultaneously receiving ketoconazole and doxorubicin. To our knowledge this unique skin manifestation of acquired cutaneous adherence has not been previously described in association with chemotherapeutic or antifungal agents. The pathogenesis of acquired cutaneous adherence in these patients might relate to therapy-induced elevation of endogenous retinoids. The similar PSA response rate in patients with or without sticky skin suggests that retinoids may not play an essential role in the mechanism of antitumor activity of ketoconazole and doxorubicin.