Skin Toxicities associated with Cancer Treatments

The incidence of cancer diagnoses continues to increase annually, with estimates suggesting that one in two individuals will be affected during their lifetime. Chemotherapy, immunotherapy, targeted therapy and radiotherapy are essential components of cancer management. However, these treatments frequently result in skin toxicity which is one of the most common adverse effects experienced by patients undergoing cancer treatment. Many cancer drugs, including chemotherapy agents, targeted therapies, and immunotherapies, can lead to skin-related side effects varying from mild irritations to severe dermatological conditions. These toxicities not only affect a patient’s quality of life but may also necessitate dose adjustments or the discontinuation of treatment, ultimately impacting the therapeutic outcome.

In this section we aim to provide relevant management guideline links, patient information and updates on educational meetings and courses.

Types of Skin Toxicities

Cancer drugs can cause a wide range of skin toxicities, broadly classified as follows:

Rashes: Often associated with immunotherapy and targeted therapies can range from mild to the more Severe Cutaneous Adverse Events (SCAR). Epidermal growth factor receptor (EGFR) inhibitors are also associated with a high rate of skin toxicity most commonly causing papulopustular eruptions on the face, chest, and back. Toxic erythema associated with chemotherapy can also occur with a range of medications.
Hand-foot syndrome: Linked to chemotherapeutic agents like capecitabine and doxorubicin, this condition causes redness, swelling, and pain on the palms of the hands and soles of the feet.
Dry skin (xerosis) and Pruritus: Common with many cancer drugs, dry skin can lead to itching and irritation.
Nail toxicity: Chemotherapy and targeted therapies can result in nail discoloration, splitting, or painful inflammation around the nail bed and severe debilitating paronychia.
Photosensitivity: Certain cancer drugs increase sensitivity to sunlight, causing sunburn-like reactions even with minimal UV exposure.
Hair changes: Drugs may cause alopecia (hair loss) and hypertrichosis as well as brittle hair, or changes in hair texture and pigmentation.
Mucositis: Can be severely debilitating and associated with a number of medications.
Dyspigmentation: Such as flagellate dermatitis with bleomycin as well as loss of pigmentation in immunotherapy associated vitiligo like eruptions.
Radiotherapy: Specific side effects including recall reaction and radiodermatitis

Impact on patients, management guidelines and patient information leaflets

Skin toxicity can significantly affect patients both physically and emotionally. Severe irritations and pain may limit daily activities, while visible skin changes can lead to self-consciousness and emotional distress. In addition, skin complications may be severe resulting in interruptions and discontinuation to treatment schedules, potentially reducing the efficacy of cancer therapy. In this section of the website, we will include patient information leaflets to give to patients and provide links to relevant management guidelines.

Management Strategies

Effective management of skin toxicity is crucial for maintaining the quality of life and ensuring the continuation of cancer treatment. Management strategies include:

Preventive Measures

Educating patients about potential skin side effects and early warning signs.
Encouraging the use of gentle skin cleansers and emollients to maintain hydration.
Advising against prolonged sun exposure and promoting high-SPF sunscreens.

Recent Advancements

Ongoing research aims to better understand the molecular basis of skin toxicities and develop targeted interventions. Some advancements include:

Biomarker identification to predict patients at higher risk of skin reactions.
Development of topical formulations containing anti-inflammatory agents.
Exploration of genetic factors contributing to individual susceptibility to drug-induced skin toxicities.

Continued research and collaboration between oncologists and dermatologists hold the promise of further advancements, ultimately improving patient care and therapeutic efficacy.

Please click on the following links for:

Skin Care Advice for patients on Immunotherapy Treatment

Immunotherapy Cutaneous Toxicity Guidelines*

*Kindly provided by Dr Andy Muinonen-Martin (Leeds Teaching Hospital), with Melanoma Focus guidelines due to be published this year.