Management of dermatologic adverse events from cancer therapies: recommendations of an expert panel

Abstract

With the development of new cancer therapies, systemic toxicity profile and effects on survival achieved an important improvement. However, a constellation of toxicities has emerged, even more remarkably, cutaneous adverse events. This report, developed by a board of Brazilian experts in oncodermatology, aims to establish a guideline for the dermatological care of oncologic patients. When possible, evidence-based recommendations were made, but in many cases, when strong evidence was not available, a consensus was reached, based on some data supporting therapies combined with personal experiences.

Keywords: Antineoplastic agents; Antineoplastic agents, immunological; Dermatology; Drug-related side effects and adverse reactions; Medical oncology; Molecular targeted therapy.

Figure 1

Different hyperpigmentation patterns: (A) serpentine supravenous hyperpigmentation after peripheral chemotherapy infusion (fluorouracil); (B) nail plate pigmentation (daunorubicin); (C) acral lentiginoses (doxorubicin).

Figure 2

Flagellate dermatitis associated to bleomycin treatment: (A) pruritic erythematous linear streaks, (B) followed by linear pigmentation.

Figure 3

PATEO syndrome (PeriArticular Thenar Erythema and Onycholysis): docetaxel treated patient presenting with (A) erythematous lesions with a distinct distribution to the dorsal aspects of the hands and (B) associated nail changes – subungual hemorrhage and onycholysis.

Figure 4

EGFR inhibitors related adverse events: (A and B) inflammatory papulopustular rash with associated xerosis (*); (C) trychomegaly and hypertrichosis; (D) periungual fissures and (E) pyogenic granuloma-like lesions. (A, B, D and E on cetuximab treated patients; C on panitumumab treated patient).

Figure 5

Toxic erythema of chemotherapy (TEC): combination of different lesions caused by direct toxicity of chemotherapy agents with (A) lesions on flexural areas (intertriginous eruption associated with chemotherapy) and (B) on palms and soles (Hand-foot syndrome – HFS).

Figure 6

Hand-foot skin reaction (HFSR) associated with antiangiogenic agents (VEGFRi): (A) hyperkeratotic lesions (sorafenib) and (B) bullous lesions (axitinib) on areas of pressure and friction.

Figure 7

BRAF inhibitor related adverse events: multiple keratoachantomas (A) and low grade squamous cell carcinomas (B) after withdrawal of MEK inhibitor and maintenance of BRAF inhibitor; (C) associated keratosis pilaris-like eruption on the lower limbs.