A 35-year-old lady was diagnosed with a left-sided breast cancer (infiltrating ductal carcinoma, grade 2, estrogen receptor/progesterone receptor positive, human epidermal growth factor receptor 2 negative). She received neoadjuvant anthracycline-based chemotherapy, followed by breast conserving surgery. Postoperatively she commenced weekly paclitaxel 80 mg/m2/week. After the 8th dose, she presented with painful swelling of hands, feet and a bilateral symmetrical rash over the extensor surfaces of legs up to the knees-ill-defined macules, papules and pustules with surrounding erythema [Figures ​[Figures1a1a and ​andb].b]. She improved with a 5-day course of low dose oral prednisolone and an oral antibiotic. Chemotherapy was terminated and she was started on adjuvant tamoxifen.

| Fig. 1a Severe skin toxicity due to weekly paclitaxel-bilaterally symmetrical rash over the extensor surfaces of legs up to knees comprising of ill-defined macules, papules and pustules with surrounding erythema

| Fig. 1b Swelling of the hands with ill-defined macules and papules with diffuse erythema

| Fig. 1a Severe skin toxicity due to weekly paclitaxel-bilaterally symmetrical rash over the extensor surfaces of legs up to knees comprising of ill-defined macules, papules and pustules with surrounding erythema

| Fig. 1b Swelling of the hands with ill-defined macules and papules with diffuse erythema