Barrier protective use of skin care to prevent chemotherapy-induced cutaneous symptoms and to maintain quality of life in patients with breast cancer

Abstract

Purpose: Chemotherapy with anthracyclines, taxanes, or alkylating agents often causes cutaneous side effects. Nonspecific inhibition of the proliferative activity of keratinocytes has antidifferentiation effects that lead to defects in the barrier function and, thus, to dry, itchy, and irritable skin. These cutaneous symptoms reduce the quality of life of the patients considerably. Conditioning with topical application of niacinamide uses the cytoprotective and barrier stabilizing effect of vitamin B3.

Patients and methods: A multicenter randomized crossover study investigated the influence of the test preparation on the quality of life compared to standard care for 73 patients with breast cancer undergoing adjuvant or neoadjuvant cytostatic therapy. Primary target parameter was the Dermatology Life Quality Index with its respective subscales after 6 weeks of a twice-daily application of the respective preparations. Additionally, specific symptoms such as pruritus, dryness, and irritability have been assessed using visual analog scales.

Results: Regarding the total score of the Dermatology Life Quality Index, no relevant differences could be observed. However, the results for the "symptoms and feelings" subscale show a significant advantage in favor of the test preparation. Significant superiority of the test preparation could also be observed in the secondary target parameters, the visual analog scales (P<0.05).

Conclusion: The results show for the first time a significant superiority of prophylactic application of niacinamide for maintaining quality of life while undergoing cytostatic treatment.

Keywords: anthracycline; chemotherapy; niacinamide; supportive therapy; taxane.

Figure 1

CONSORT diagram. Abbreviations: SC, standard care; SC/TP, patient group that starts with SC followed by TP; TP, test preparation; TP/SC, patient group that starts with TP followed by SC; CONSORT, Consolidated Standards of Reporting Trials.

Figure 2

DLQI: comparison of both groups over application time. Notes: (A) DLQI total, (B) DLQI SF. SC/TP group SC/TP group n=48; TP/SC group n=46. *Statistical significant difference between the groups, analysis of variance (P≤0.05). Abbreviations: DLQI, Dermatology Life Quality Index; SF, subscale Symptoms and Feelings.

Figure 3

VAS: comparison of both groups over application time. Notes: (A) Pruritus, (B) skin dryness, (C) irritability. Standard care/test preparation group n=48; test preparation/standard care group n=46. *Statistical significant difference between the groups, analysis of variance (P≤0.05). Abbreviation: VAS, visual analog scale.