Cutaneous Reactions to Chemotherapy and their Management

Abstract

International data from 2002 report 10.9 million new cases of cancer and 6.7 million cancer deaths. Chemotherapy is an essential component in the multidisciplinary management of most cancers. Cutaneous reactions to chemotherapeutics are common and may contribute significantly to the morbidity, and rarely to the mortality, of patients undergoing such treatments. Recognition and management of these reactions is important to provide optimal care. This article aims to present the most common cutaneous reactions to frequently used chemotherapies and provides management guidelines. A MEDLINE search from 1966 through June 2005 was conducted to identify reports of common cutaneous toxicities with systemic chemotherapy and their appropriate management. An analysis of our literature search is presented in review form outlining common chemotherapy-related cutaneous reactions and their management, as well as the chemotherapeutics responsible for the cutaneous toxicity. Chemotherapy-related cutaneous toxicity includes generalized rashes such as the spectrum between erythema multiforme and toxic epidermal necrolysis, and site-specific toxicity such as mucositis, alopecia, nail changes, extravasation reactions, or hand-foot syndrome. Most of the toxicity is reversible with chemotherapy dose reductions or delays. Certain toxicities can be effectively treated or prevented, allowing optimal delivery of chemotherapy (e.g. premedications to prevent hypersensitivity, prophylactic mouthwashes to prevent mucositis). Newer non-chemotherapeutic targeted therapies such as epidermal growth factor receptor inhibitors (e.g. gefitinib, cetuximab) may also be associated with cutaneous toxicity and can be distressing for patients. Recent data suggest that skin toxicity associated with these agents may correlate with efficacy. Cutaneous toxicity occurs frequently with chemotherapy and non-chemotherapeutic biologic therapies. Early recognition and treatment of the toxicity facilitates good symptom control, prevents treatment-related morbidity, and allows continuation of anti-cancer therapy.

Hand-Foot Syndrome (Hand-Foot Skin Reaction, Palmar-Plantar Erythrodysesthesia): Focus on Sorafenib and Sunitinib

“…More than a dozen other chemotherapeutic agents have been implicated [6,7], including traditional doxorubicin, docetaxel, cisplatin, cyclophosphamide, daunorubicin, doxifluridine, etoposide, floxuridine, hydroxyurea, mercaptopurine, methotrexate, mitotane, paclitaxel, tegafur, vinorelbine, epirubicin, and gefitinib [1,6,24,25,26,27,28,29,30,31,32,33]. These agents encompass a wide range of medication classes with distinct mechanisms of action, including intercalating agents, anti-mitotics, anti-metabolites, topoisomerase inhibitors, and epidermal growth factor receptor antagonists.…”

Erlotinib-responsive actinic keratoses

“…Other conventional chemotherapeutic agents which have been associated with the inflammation of actinic keratosis include docetaxel, doxorubicin, capecitabine, pentostatin, sorafenib and the combination of dactinomycin, vincristine, dacarbazine and doxorubicin, cytarabine and 6-thioguanine (8,12,23,24). The mechanism by which these agents lead to this effect is unknown, although abnormal DNA synthesis and a form of radiation recall have been postulated (12).…”

“…These unwanted reactions are quite typical for this drug family, and distinct from the skin adverse effects related to other types of anti-cancer chemotherapy (8). The most frequent skin manifestation following anti-EGFR treatment consists of an acneiform pustular eruption (9)(10)(11).…”

Reações tegumentares adversas relacionadas aos agentes antineoplásicos: parte I

“…Nearly all antineoplastic agents can lead to reduction of growth speed, nail fragility, Mees' lines and Beau's lines. [13][14][15][16] Hyperpigmentation can occur due to the use of cyclophosphamide, hydroxyurea, fluoropirimidines, such as 5-fluorouracil (5-FU) and specially anthracyclines like doxorubicin and daunorubicin ( Figure 2). [17][18][19] Painful onycholycosis and subungueal abcesses are due to the use of taxanes (docetaxel/paclitaxel) and anthracyclines (doxorubicin).…”