The field of oncodermatology has emerged as a result of remarkable advances in cancer treatment. Unlike traditional chemotherapy, targeted anticancer agents such as epidermal growth factor receptor (EGFR) inhibitors are associated with decreased systemic toxicities.
These agents do, however, present a unique set of dermatologic toxicities which can have an impact on the quality of life of patients undergoing treatment. One of the most characteristic examples is the papulopustular acneiform eruption seen with EGFR inhibitors, which is observed in almost 80 percent of patients on therapy. This skin toxicity can be severe enough to result in a dose modification in 70 percent of patients and discontinuation in 30 percent of patients on treatment. Other dermatologic toxicities associated with targeted therapy may include benign or malignant skin growths, pruritus, photosensitivity, or nail changes such as paronychia.
The introduction of immune checkpoint inhibitors has revolutionized the treatment of advanced cancer. By releasing the body’s own antitumor immune response, immunotherapy offers the potential for long-term, progression-free survival. In turn, however, immune-related adverse effects (irAEs) across organ systems occur in 80 percent of patients on treatment and may be severe and treatment limiting. Notably, skin toxicities, which may occur in up to 60 percent of patients, are the earliest and most frequently encountered adverse events during treatment.
The most common skin toxicities encountered with immunotherapy include rash, pruritus, and vitiligo. Others may resemble autoimmune diseases such as lupus, lichen planus, or psoriasis. Worsening of pre-existing skin diseases, such as eczema or psoriasis, may also occur.
Education, prevention, early recognition, and initiation of treatment for skin toxicities may prevent the delay or discontinuation of cancer treatment. Dry skin care and sunprotection are essential. Maintaining a good dry skin care regimen is key for patients on cancer therapy. This includes taking lukewarm, short showers limited to five to 10 minutes, using mild soaps or cleansers, gently patting the skin dry, and applying a moisturizer immediately after bathing. Sunprotection also plays a vital role.
For dermatologists, skin toxicities resulting from targeted anticancer agents or immunotherapy are likely familiar rashes, just in an unfamiliar setting. Prior studies have shown that the recognition, prevention, and treatment of skin toxicities may help to improve the quality of life of patients undergoing cancer treatment and allow for continuing therapy. Supportive oncodermatology provides an opportunity for a multidisciplinary approach to cancer, with a common goal to provide supportive care to allow patients to remain on potentially life-saving cancer therapies.
Rajini K. Murthy MD practices dermatology at Total Skin & Beauty Dermatology Center.
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