Skin care in oncology patients is an essential but often underemphasized component of supportive cancer therapy. Many chemotherapy agents, targeted therapies, radiation treatments, and immunotherapies cause a range of cutaneous adverse effects that can significantly impact quality of life, adherence to cancer treatment, and even clinical outcomes. Dermatologic toxicities are among the most common non-hematologic adverse events reported by oncology patients.
Chemotherapeutic agents, particularly antimetabolites like 5-fluorouracil and cytarabine, can cause skin dryness, peeling, hyperpigmentation, and hand-foot syndrome (palmar-plantar erythrodysesthesia). Radiation therapy frequently leads to radiation dermatitis, characterized by erythema, edema, desquamation, and in severe cases, ulceration. Targeted therapies, especially epidermal growth factor receptor (EGFR) inhibitors such as cetuximab and erlotinib, often induce acneiform eruptions, xerosis, paronychia, and hair changes. Immune checkpoint inhibitors (nivolumab, pembrolizumab) are associated with immune-related skin disorders, including vitiligo, lichenoid dermatitis, and rare cases of severe bullous eruptions.
Preventive skin care strategies play a critical role in reducing the severity of these adverse effects. Basic recommendations include daily use of gentle, fragrance-free cleansers, liberal application of emollients to maintain the skin barrier, and strict photoprotection with broad-spectrum sunscreens. For patients receiving EGFR inhibitors, prophylactic treatment with topical corticosteroids and oral tetracyclines has been shown to reduce the incidence and severity of acneiform rash. Early intervention and consistent moisturization can significantly decrease the severity of hand-foot syndrome, while topical corticosteroids and barrier creams are standard in managing radiation dermatitis.
Pharmacists are vital in recognizing cutaneous toxicities early, counseling patients on appropriate skin care regimens, recommending over-the-counter supportive therapies, and triaging patients for dermatologic referral when necessary. In some cases, pharmacists also assist with prescribing or recommending agents for symptomatic relief, such as topical steroids for inflammatory eruptions, or urea-based creams for hyperkeratosis. Moreover, understanding when to advocate for dose modification or temporary interruption of oncologic therapy is crucial when dermatologic adverse events significantly impair patient functioning or pose risks for secondary infection. Comprehensive skin care planning should be considered a core element of oncology supportive care, and pharmacists are well positioned to lead education efforts, minimize complications, and improve patient quality of life during treatment.
Lacouture ME, Anadkat MJ, Bensadoun RJ, et al. Clinical practice guidelines for the prevention and treatment of EGFR inhibitor–associated dermatologic toxicities. Support Care Cancer. 2011;19(8):1079–1095. doi:10.1007/s00520-011-1197-6– Guideline for managing cutaneous adverse effects of targeted cancer therapies, especially EGFR inhibitors.
Wong RK, Bensadoun RJ, Boers-Doets CB, Sonis ST. Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC Skin Toxicity Study Group. Support Care Cancer. 2013;21(10):2933–2948. doi:10.1007/s00520-013-1896-2– Evidence-based recommendations for managing radiation dermatitis and related skin effects.
Hu JC, Torres JS, Leventhal JS. Cutaneous adverse effects of immune checkpoint inhibitors: recognition and management. Am J Clin Dermatol. 2021;22(6):757–771. doi:10.1007/s40257-021-00609-4– Review of dermatologic toxicities related to immune checkpoint blockade therapies and treatment guidance.
Bensadoun RJ, Humbert P, Krutman J, et al. Daily care of skin for cancer patients: recommendations from an expert panel. Support Care Cancer. 2020;28(7):3301–3308. doi:10.1007/s00520-020-05359-w– Comprehensive guidance on skin hygiene, moisturization, and photoprotection in oncology care.
Skin care in oncology patients is an essential but often underemphasized component of supportive cancer therapy. Many chemotherapy agents, targeted therapies, radiation treatments, and immunotherapies cause a range of cutaneous adverse effects that can significantly impact quality of life, adherence to cancer treatment, and even clinical outcomes. Dermatologic toxicities are among the most common non-hematologic adverse events reported by oncology patients.
Chemotherapeutic agents, particularly antimetabolites like 5-fluorouracil and cytarabine, can cause skin dryness, peeling, hyperpigmentation, and hand-foot syndrome (palmar-plantar erythrodysesthesia). Radiation therapy frequently leads to radiation dermatitis, characterized by erythema, edema, desquamation, and in severe cases, ulceration. Targeted therapies, especially epidermal growth factor receptor (EGFR) inhibitors such as cetuximab and erlotinib, often induce acneiform eruptions, xerosis, paronychia, and hair changes. Immune checkpoint inhibitors (nivolumab, pembrolizumab) are associated with immune-related skin disorders, including vitiligo, lichenoid dermatitis, and rare cases of severe bullous eruptions.
Preventive skin care strategies play a critical role in reducing the severity of these adverse effects. Basic recommendations include daily use of gentle, fragrance-free cleansers, liberal application of emollients to maintain the skin barrier, and strict photoprotection with broad-spectrum sunscreens. For patients receiving EGFR inhibitors, prophylactic treatment with topical corticosteroids and oral tetracyclines has been shown to reduce the incidence and severity of acneiform rash. Early intervention and consistent moisturization can significantly decrease the severity of hand-foot syndrome, while topical corticosteroids and barrier creams are standard in managing radiation dermatitis.
Pharmacists are vital in recognizing cutaneous toxicities early, counseling patients on appropriate skin care regimens, recommending over-the-counter supportive therapies, and triaging patients for dermatologic referral when necessary. In some cases, pharmacists also assist with prescribing or recommending agents for symptomatic relief, such as topical steroids for inflammatory eruptions, or urea-based creams for hyperkeratosis. Moreover, understanding when to advocate for dose modification or temporary interruption of oncologic therapy is crucial when dermatologic adverse events significantly impair patient functioning or pose risks for secondary infection. Comprehensive skin care planning should be considered a core element of oncology supportive care, and pharmacists are well positioned to lead education efforts, minimize complications, and improve patient quality of life during treatment.
Lacouture ME, Anadkat MJ, Bensadoun RJ, et al. Clinical practice guidelines for the prevention and treatment of EGFR inhibitor–associated dermatologic toxicities. Support Care Cancer. 2011;19(8):1079–1095. doi:10.1007/s00520-011-1197-6– Guideline for managing cutaneous adverse effects of targeted cancer therapies, especially EGFR inhibitors.
Wong RK, Bensadoun RJ, Boers-Doets CB, Sonis ST. Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC Skin Toxicity Study Group. Support Care Cancer. 2013;21(10):2933–2948. doi:10.1007/s00520-013-1896-2– Evidence-based recommendations for managing radiation dermatitis and related skin effects.
Hu JC, Torres JS, Leventhal JS. Cutaneous adverse effects of immune checkpoint inhibitors: recognition and management. Am J Clin Dermatol. 2021;22(6):757–771. doi:10.1007/s40257-021-00609-4– Review of dermatologic toxicities related to immune checkpoint blockade therapies and treatment guidance.
Bensadoun RJ, Humbert P, Krutman J, et al. Daily care of skin for cancer patients: recommendations from an expert panel. Support Care Cancer. 2020;28(7):3301–3308. doi:10.1007/s00520-020-05359-w– Comprehensive guidance on skin hygiene, moisturization, and photoprotection in oncology care.