Chemotherapy-Related Skin Toxicities
Acneiform eruptions, or folliculitis, often begin as facial erythema that progress to papules and pustules and spread to the upper trunk. Causes of folliculitis in cancer patients include actinomycin-D (Cosmegen)—the most common—as well as epidermal growth factor receptor-inhibiting agents, such as gefitinib (Iressa) and cetuximab (Erbitux). Although the pustules contain no bacteria, oral tetracycline antibiotics can be used to manage eruptions due to the drugs’ anti-inflammatory properties.
Paronychia is an infection of the soft tissue around a finger or toenail leading to inflammation and swelling. It is a known toxicity of anti-cancer therapy with epidermal growth factor receptor-inhibiting (EGFR) agents. These drugs may affect the skin’s epidermal receptors and cause paronychia. Onset is typically within 2 months of initiating an EGFR agent, with reported incidence rates ranging between 6% and 50%.
Trichomegaly, the spontaneous, excessive growth of eyelash with a specifically curly texture, is a toxicity associated with epidermal growth factor receptor-inhibiting (EGFR) use, particularly erlotinib (Tarceva, generic), gefitinib (Iressa), and cetuximab (Erbitux). Researchers hypothesize that trichomegaly may help predict tumor response during EGFR blockade treatment. The biologic significance of trichomegaly remains unknown.
Patients undergoing chemotherapy with taxanes (docetaxel [Docefrez, Taxotere, generics] and paclitaxel [Abraxane, generics]) and anthracyclines (doxorubicin [Doxil, generics], idarubicin [Idamycin PFS, generics], and epirubicin [Ellence, generics]) are prone to nail changes including Beau line or transverse grooves in the nail plate (pictured), onycholysis, onychomadesis, and thickening/thinning of the nail. Nail pain may require pain medication. New growth typically resolves these conditions.
The chemotherapy drugs fluorouracil (Carac, Effudex, Fluoroplex, generics), vinorelbine (Navelbine, generics), and daunorubicin (Cerubidine, Daunoxome) cause hyperpigmentation of the skin, nails, and oral mucosa. Hyperpigmentation can follow the distribution of veins, known as serpentine supravenous hyperpigmentation, or can be patchy and macular. Topical hydroquinone can decrease melanin production and help clear hyperpigmentation. The disorder typically resolves when chemotherapy is stopped.
Cancer diagnosis incidence is increasing worldwide as the population grows and people continue to live longer. As a result chemotherapy-related skin toxicities are on the rise, and clinicians and patients alike should be prepared to recognize these disorders.