Toxic reaction to prolonged high-dose fluorouracil.

To the Editor.— Based on the information and photograph presented by Drs Feldman and Ajani 1 in their PHOTO/ESSAY, I am unable to accept their conclusion that this represents a "toxic reaction to fluorouracil." A hyperkeratotic erythematous eruption involving the feet in a "moccasin distribution" and the palmar aspect of the hands is much more likely to be dermatophytosis or pityriasis rubra pilaris. No evidence was presented that would eliminate the possibility of a fungal etiology for these lesions. The biopsy results as stated do not rule out either dermatophytosis or pityriasis rubra pilaris. The photographed foot the authors present does not resemble bleomycin-associated Raynaud's phenomenon or the "peculiar acral erythema" described by Burgdorff et al. 2