Managing dermatologic changes of targeted cancer therapy

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Managing dermatologic changes of targeted cancer therapy

J Fam Pract. 2019 July;68(6):334-340

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References

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Risk of infection and the role of antibiotics

Skin damage can lead to further complications—namely, leaving the skin vulnerable to bacterial overgrowth and serious infection.¹⁴The primary acneiform eruption is believed to be inflammatory in nature, with most cases being sterile and lacking bacterial growth.²⁵ However, rash-associated infections are a common complication and leave the immunocompromised patient at risk of systemic infection: Harandi et al²⁶ reported a 35% rate of secondary infection. Viral or bacterial growth (the primary pathogen is Staphylococcus aureus) within the wound can aggravate the severity of the rash, prohibit effective healing, and exacerbate the disfiguring appearance of the rash.

When a patient reports a painful rash, collaborate with the dermatologist and oncologist to make adjustments to the cancer treatment plan.

The use of a prophylactic antibiotic for treating a rash in this setting has been an active area of discussion and research, although no guidelines or recommendations exist that can be routinely employed. A comprehensive systematic review and meta-analysis demonstrated that, in patients undergoing EGFR-based therapy, those who received a prophylactic antibiotic had a lower risk of developing folliculitis than those who did not (odds ratio = 0.53; 95% confidence interval, 0.39-0.72; P < .01).²⁷

A consensus agreement on the use of prophylactic antibiotics has yet to be reached. An emerging clinical practice entails the use of oral minocycline (100 mg/d) during the first 4 weeks of EGFRI-based therapy because studies have shown a benefit from this regimen in reducing eruptions.²⁸

Other adverse dermatologic effects to watch for

Paronychia is common in patients undergoing EGFRI therapy but, unlike the acneiform rash that typically occurs within 1 week of treatment, paronychia can occur weeks or months after initiation of therapy. Careful examination of the nail beds is important in patients undergoing EGFRI therapy (FIGURE 1B). Paronychia can affect the nail beds of the fingers and toes—most often, the first digits.²⁹

No evidence-based trials have been conducted to evaluate treatment options; recommendations provided are drawn from the literature and expert opinion. Patients are encouraged to apply petroleum jelly or an emollient daily both as a preventive measure and for mild cases. Patient counseling on the importance of nail hygiene and avoidance of aggressive manicures and pedicures is encouraged.³⁰

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