Dermatologic conditions in women receiving systemic cancer therapy

Abstract

As advances in cancer therapies have improved cancer-related survival, novel therapeutics have also introduced a variety of dermatologic toxicities, and an increased number of patients are living with these sequalae. Women with cancer in particular experience a spectrum of dermatologic conditions that affect their skin, hair, nail, and mucosal surfaces. Studies have shown that these toxic effects can significantly affect quality of life and alter a woman's self-image, cultural identity, femininity, sexuality, and mental health. In severe instances, dermatologic toxicities may even disrupt cancer therapy and can therefore affect overall survival and treatment response. In this article, we review the dermatologic adverse effects from traditional chemotherapy, targeted therapy, immune checkpoint inhibitors, and endocrine therapy that disproportionately affect women. The timely diagnosis and management of these dermatologic conditions is crucial in the multidisciplinary care of women with cancer.

Keywords: Cancer therapy; Cutaneous adverse effects; Dermatologic toxicities; Oncodermatology; Women’s health.

Fig. 1

(A) Diffuse, nonscarring alopecia of the scalp as a result of taxane chemotherapy-induced anagen effluvium in a patient with breast cancer; (B) chemotherapy-induced permanent alopecia of the mid-scalp and crown after taxane chemotherapy for breast cancer; (C) scalp cooling during chemotherapy infusion with a manual cold cap to prevent chemotherapy-induced alopecia.

Fig. 2

(A) Well-demarcated palmar erythema and edema consistent with hand-foot syndrome or toxic erythema of chemotherapy from capecitabine treatment for breast cancer; (B) subungual hemorrhage with distal onycholysis of the nails during taxane chemotherapy.

Fig. 3

(A) Inflammatory papules and pustules with impetiginization (positive culture for methicillin-resistant Staphylococcus aureus) on the face consistent with the papulopustular eruption during epidermal growth factor receptor (EGFR) inhibitor therapy for lung cancer; (B) scarring alopecia as a result of severe EGFR inhibitor-induced papulopustular eruption involving the scalp or a woman with lung cancer; (C) periungual erythema and swelling with painful pyogenic granuloma-like lesion along the lateral nailfold due to EGFR inhibitor therapy; (D) eyelash trichomegaly in a patient on EGFR inhibitor therapy; (E) hand-foot skin reaction manifesting as focal hyperkeratotic plaques with an erythematous base on the fingertips during treatment with sorafenib.

Fig. 4

(A) Lichenoid dermatitis presenting as discrete pink-violaceous papules and plaques with overlying white scale on the arm during treatment with the anti-PD-1 agent nivolumab; (B) tense bullae and urticarial plaques on the abdomen characteristic of bullous pemphigoid in a patient on anti-PD-1 therapy for metastatic melanoma.

Fig. 5

Hair thinning over the crown of scalp during tamoxifen therapy for breast cancer, consistent with endocrine therapy-associated female pattern hair loss.