Article

Skin Toxicities: Common Side Effect

cancer, symptoms, side effects, long-term side effects, survivorship care
CJON 2021, 25(6), 32-32. DOI: 10.1188/21.CJON.S2.32

Cancer treatment–related skin toxicities are a frequent and distressing side effect of antineoplastic therapies, particularly chemotherapy and targeted therapies. Toxicities associated can appear as rashes, hand-foot skin reaction, hand-foot syndrome, and hair loss. As many as 90% of patients will experience some skin toxicity at some point in their therapy.

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    For skin toxicities, standards of care are based on established evidence-based practice.

    Definition

    •  Cancer treatment–related skin toxicities are a frequent and distressing side effect of antineoplastic therapies, particularly chemotherapy and targeted therapies. Toxicities associated can appear as rashes, hand-foot skin reaction, hand-foot syndrome, and hair loss.

    Incidence

    •  As many as 90% of patients will experience some skin toxicity at some point in their therapy.

    •  Chronic radiation dermatitis can occur months to years after treatment, manifesting as hyperpigmentation, radiation-induced fibrosis, pain, and increased risk of secondary cutaneous malignancies.

    Assessment Tools and Recommended Intervals

    •  Identify and grade physical symptoms (size of lesions and extent of rash, extent of body surface area affected, presence of inflammation, and signs of infection).

    •  Subjective assessment includes impact on quality of life, severity (intensity, timing, duration, and characteristics), associated symptoms, distress, and aggravating and relieving factors.

    Prevention Measures

    •  Use mild soap and water for routine bathing, a cream-based moisturizer, and a broad-spectrum sunscreen SPF 30 or higher.

    •  Educate patients on prevention.

    Evidence-Based Interventions and Management

    •  Use topical corticosteroids and oral antibiotics in addition to usual skin care.

    •  Antibiotic therapy with tetracycline, minocycline, or doxycycline can be considered in the prophylactic setting for patients on epidermal growth factor receptor inhibitors.

    •  For individuals receiving multikinase inhibitors at risk for hand-foot skin reaction, use topical urea and topical steroids in addition to usual care.

    •  For individuals with cancer receiving cytotoxic agents associated with chemotherapy-induced alopecia who are concerned about alopecia, advise scalp cooling to minimize or reduce the symptom severity.

    Agents and Interventions to Avoid

    •  Avoid topical products with fragrances or alcohol, which can dry the skin.

    Evidence-Based Resources for Providers

    •  ONS Guidelines™ for Cancer Treatment–Related Skin Toxicity (www.ons.org/pep/skin-reactions)

    Evidence-Based Resources for Patients and Family

    •  ONS Guidelines™ for Cancer Treatment–Related Skin Toxicity (www.ons.org/pep/skin-reactions)

    About the Author(s)

    Suzanne M. Mahon, DNS, RN, AOCN®, AGN-BC, FAAN, is a professor in the Department of Internal Medicine in the Division of Hematology/Oncology and in the Trudy Busch Valentine School of Nursing at Saint Louis University in Missouri and Ellen Carr, PhD, RN, AOCN®, is the editor of the Clinical Journal of Oncology Nursing at the Oncology Nursing Society in Pittsburgh, PA. The authors take full responsibility for this content. The article has been reviewed by independent peer reviewers to ensure that it is objective and free from bias. Mahon can be reached at suzanne.mahon@health.slu.edu, with copy to CJONEditor@ons.org. (Submitted June 2021. Accepted August 26, 2021.)

     

    References

    Ding, J., Farah, M.H., Nayfeh, T., Malandris, K., Manolopoulos, A., Ginex, P.K., . . . Murad, M.H. (2020). Targeted therapy– and chemotherapy-associated skin toxicities: Systematic review and meta-analysis. Oncology Nursing Forum, 47(5), E149–E160. https://doi.org/10.1188/20.ONF.E149-E160
    Williams, L.A., Ginex, P.K., Ebanks, G.L., Jr., Ganstwig, K., Ciccolini, K., Kwong, B.Y., . . . Morgan, R.L. (2020). ONS Guidelines™ for cancer treatment–related skin toxicity. Oncology Nursing Forum, 47(5), 539–556. https://doi.org/10.1188/20.ONF.539-556