Skip to main content

Advertisement

SpringerLink
Log in

Cutaneous Manifestations of Chemotherapeutic Drugs

  • Hospital-based Dermatology (D. Kroshinsky, Section Editor)
  • Published:
Current Dermatology Reports Aims and scope Submit manuscript

Abstract

Chemotherapy is well known to both clinicians and patients for its ability to cause unwanted adverse effects. The skin is an organ commonly affected by treatment with chemotherapy, leading to presentations ranging from mild to life-threatening. Recognition of these cutaneous effects is important as they impact morbidity and mortality as well as patient compliance. This review aims to discuss several of the most common cutaneous side effects of chemotherapies as well as recommendations for their diagnosis and management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.

    Article  CAS  PubMed  Google Scholar 

  2. Chen AP, Setser A, Anadkat MJ, Cotliar J, Olsen EA, Garden BC, et al. Grading dermatologic adverse events of cancer treatments: the Common Terminology Criteria for Adverse Events Version 4.0. J Am Acad Dermatol. 2012;67:1025–39. This paper is a comprehensive review of the NCI CTCAE criteria specific to dermatologic adverse events.

    Article  PubMed  Google Scholar 

  3. Bolognia JL, Cooper DL, Glusac EJ. Toxic erythema of chemotherapy: a useful clinical term. J Am Acad Dermatol. 2008;59:524–9. This paper defined the term “toxic erythema of chemotherapy”, which allowed for consolidation of clinical terminology and improved communication between clinicians.

    Article  PubMed  Google Scholar 

  4. Miller KK, Gorcey L, McLellan BN. Chemotherapy-induced hand-foot syndrome and nail changes: a review of clinical presentation, etiology, pathogenesis, and management. J Am Acad Dermatol Elsevier. 2014;71:787–94.

    Article  Google Scholar 

  5. Reyes-Habito CM, Roh EK. Cutaneous reactions to chemotherapeutic drugs and targeted therapies for cancer. J Am Acad Dermatol Elsevier. 2014;71:203.e1–203.e12.

    Article  CAS  Google Scholar 

  6. Al-Ahwal MS. Chemotherapy and fingerprint loss: beyond cosmetic. Oncologist. 2012;17:291–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Do JE, Kim YC. Capecitabine-induced diffuse palmoplantar keratoderma: is it a sequential event of hand-foot syndrome? Clin Exp Dermatol. 2007;32:519–21.

    Article  CAS  PubMed  Google Scholar 

  8. Zhang RX, Wu XJ, Wan DS, Lu ZH, Kong LH, Pan ZZ, et al. Celecoxib can prevent capecitabine-related hand-foot syndrome in stage II and III colorectal cancer patients: result of a single-center, prospective randomized phase III trial. Ann Oncol. 2012;23:1348–53.

    Article  CAS  PubMed  Google Scholar 

  9. Templeton AJ, Ribi K, Surber C, Sun H, Hsu Schmitz S-F, Beyeler M, et al. Prevention of palmar–plantar erythrodysesthesia with an antiperspirant in breast cancer patients treated with pegylated liposomal doxorubicin (SAKK 92/08). Breast. 2014;23:244–9.

    Article  PubMed  Google Scholar 

  10. Carvalho R, Macias V, Marques-Pinto G, Afonso A, Cardoso J. Intertriginous pattern of toxic erythema of chemotherapy. Cutan Ocul Toxicol. 2011;30:309–11.

    Article  CAS  PubMed  Google Scholar 

  11. Wolf R, Tüzün Y. Baboon syndrome and toxic erythema of chemotherapy: fold (intertriginous) dermatoses. Clin Dermatol. 2015;33:462–5.

    Article  PubMed  Google Scholar 

  12. Murad A, Fortune A, Moloney FJ. Violaceous perivulvar nodular eruption after chemotherapy. JAMA Dermatol Am Med Assoc. 2014;150:1003–4.

    Article  Google Scholar 

  13. Nijsten TEC, Meuleman L, Lambert J. Chronic pruritic neutrophilic eccrine hidradenitis in a patient with Behçet’s disease. Br J Dermatol. 2002;147:797–800.

    Article  CAS  PubMed  Google Scholar 

  14. Rouanet I, Jantac M, Lechiche C, Hope-Rapp E, Sotto A. Neutrophilic eccrine hidradenitis in an HIV-1-infected patient. AIDS. 2012;26:775–6.

    Article  PubMed  Google Scholar 

  15. Dasanu CA, Bockorny B. Recurrent pseudocellulitis due to gemcitabine: underrecognized and underreported? J Oncol Pharm Pract. 2015;21:377–9.

    Article  PubMed  Google Scholar 

  16. Macdonald JB, Macdonald B, Golitz LE, LoRusso P, Sekulic A. Cutaneous adverse effects of targeted therapies. J Am Acad Dermatol. 2015;72:203–18.

    Article  CAS  PubMed  Google Scholar 

  17. Ren Z, Zhu K, Kang H, Lu M, Qu Z, Lu L, et al. Randomized controlled trial of the prophylactic effect of urea-based cream on sorafenib-associated hand-foot skin reactions in patients with advanced hepatocellular carcinoma. JCO. Am Soc Clin Oncol. 2015;33:JCO.2013.52.9651–900.

  18. Lilly E, Burke M, Kluger H, Choi J. Pregabalin for the treatment of painful hand-foot skin reaction associated with dabrafenib. JAMA Dermatol Am Med Assoc. 2015;151:102–3.

    Article  Google Scholar 

  19. Chaveli-López B. Oral toxicity produced by chemotherapy: a systematic review. J Clin Exp Dent Medicina Oral SL. 2014;6:e81–90.

    Article  Google Scholar 

  20. McGarvey EL, Baum LD, Pinkerton RC, Rogers LM. Psychological sequelae and alopecia among women with cancer. Cancer Pract. 2001;9:283–9.

    Article  CAS  PubMed  Google Scholar 

  21. Miteva M, Misciali C, Fanti PA, Vincenzi C, Romanelli P, Tosti A. Permanent alopecia after systemic chemotherapy: a clinicopathological study of 10 cases. Am J Dermatopathol. 2011;33:345–50.

    Article  PubMed  Google Scholar 

  22. Palamaras I, Misciali C, Vincenzi C, Robles WS, Tosti A. Permanent chemotherapy-induced alopecia: a review. J Am Acad Dermatol. 2011;64(3):604–6. doi:10.1016/j.jaad.2010.03.020.

  23. Shin H, Jo SJ, Kim DH, Kwon O, Myung SK. Efficacy of interventions for prevention of chemotherapy-induced alopecia: a systematic review and meta-analysis. Int J Cancer. 2015;136:E442–54. This paper is a meta-analysis of studies evaluating efficacy of prevention strategies for chemotherapy-induced alopecia.

    Article  CAS  PubMed  Google Scholar 

  24. Robert C, Sibaud V, Mateus C, Verschoore M, Charles C, Lanoy E, et al. Nail toxicities induced by systemic anticancer treatments. Lancet Oncol. 2015;16:e181–9. Comprehensive review of chemotherapeutic effects on nail phenotypes.

    Article  CAS  PubMed  Google Scholar 

  25. Capriotti K, Capriotti JA, Lessin S, Wu S, Goldfarb S, Belum VR, et al. The risk of nail changes with taxane chemotherapy: a systematic review of the literature and meta-analysis. Br J Dermatol. 2015;173:842–5.

    Article  CAS  PubMed  Google Scholar 

  26. Scotté F, Tourani J-M, Banu E, Peyromaure M, Levy E, Marsan S, et al. Multicenter study of a frozen glove to prevent docetaxel-induced onycholysis and cutaneous toxicity of the hand. JCO. 2005;23:4424–9.

    Article  Google Scholar 

  27. Segaert S, Van Cutsem E. Clinical signs, pathophysiology and management of skin toxicity during therapy with epidermal growth factor receptor inhibitors. Ann Oncol Oxford University Press. 2005;16:1425–33.

    Article  CAS  Google Scholar 

  28. Boone SL, Rademaker A, Liu D, Pfeiffer C, Mauro DJ, Lacouture ME. Impact and management of skin toxicity associated with anti-epidermal growth factor receptor therapy: survey results. Oncology Karger Publishers. 2007;72:152–9.

    CAS  Google Scholar 

  29. Chiang HC, Palamaras I. Isotretinoin for high-grade or refractory epidermal growth factor receptor inhibitor-related acneiform papulopustular eruptions. J Am Acad Dermatol. 2013;69(4):657–8. doi:10.1016/j.jaad.2013.05.032.

  30. Wacker B, Nagrani T, Weinberg J, Witt K, Clark G, Cagnoni PJ. Correlation between development of rash and efficacy in patients treated with the epidermal growth factor receptor tyrosine kinase inhibitor erlotinib in two large phase III studies. Am Assoc Cancer Res. 2007;13:3913–21.

    CAS  Google Scholar 

  31. Yu J, Jin F, Zhu H, Kong L. A spectrum of cutaneous toxicities from erlotinib may be a robust clinical marker for non-small-cell lung therapy: a case report and literature review. OTT Dove Press. 2015;8:943–6.

    Google Scholar 

  32. Araki K, Fukada I, Horii R, Takahashi S, Akiyama F, Iwase T, et al. Lapatinib-associated mucocutaneous toxicities are clinical predictors of improved progression-free survival in patients with human epidermal growth factor receptor (HER2)-positive advanced breast cancer. Breast Cancer Res Treat Springer US. 2014;148:197–209.

    Article  CAS  Google Scholar 

  33. Boussemart L, Boivin C, Claveau J, Tao YG, Tomasic G, Routier E, et al. Vemurafenib and radiosensitization. JAMA Dermatol Am Med Assoc. 2013;149:855–7.

    Article  Google Scholar 

  34. Anforth RM, Blumetti TCMP, Kefford RF, Sharma R, Scolyer RA, Kossard S, et al. Cutaneous manifestations of dabrafenib (GSK2118436): a selective inhibitor of mutant BRAF in patients with metastatic melanoma. Br J Dermatol Blackwell Publishing Ltd. 2012;167:1153–60.

    Article  CAS  Google Scholar 

  35. Gandhi M, Oishi K, Zubal B, Lacouture ME. Unanticipated toxicities from anticancer therapies: survivors’ perspectives. Support Care Cancer Springer-Verlag. 2009;18:1461–8.

    Article  Google Scholar 

  36. Lacouture ME. Mechanisms of cutaneous toxicities to EGFR inhibitors. Nat Rev Cancer Nature Publishing Group. 2006;6:803–12.

    Article  CAS  Google Scholar 

  37. Kloos RT, Ringel MD, Knopp MV, Hall NC, King M, Stevens R, et al. Phase II trial of sorafenib in metastatic thyroid cancer. J Clin Oncol Proc Am Soc Clin Oncol. 2009;27:1675–84.

    Article  CAS  Google Scholar 

  38. Sanlorenzo M, Choudhry A, Vujic I, Posch C, Chong K, Johnston K, et al. Comparative profile of cutaneous adverse events: BRAF/MEK inhibitor combination therapy versus BRAF monotherapy in melanoma. J Am Acad Dermatol Elsevier. 2014;71:1102–1109.e1. Comparison of cutaneous side effects of BRAF inhibitors without and with MAP kinase inhibitors, including the decreased risk of cutaneous skin cancers in the latter group.

    Article  CAS  Google Scholar 

  39. Carrera C, Puig-Butillè JA, Tell-Marti G, García A, Badenas C, Alós L, et al. Multiple BRAF wild-type melanomas during dabrafenib treatment for metastatic BRAF-mutant melanoma. JAMA Dermatol. 2015;151:544–8.

    Article  PubMed  Google Scholar 

  40. Chambers CJ, Liu H, White CR, White KP, Sharon VR. Eruptive purpuric papules on the arms; a case of chemotherapy-induced inflammation of actinic keratoses and review of the literature. Dermatol Online J. 2014;20(1):21246

  41. Ali FR, Yiu ZZN, Fitzgerald D. Inflammation of actinic keratoses during paclitaxel chemotherapy. BMJ Case Rep. BMJ Publishing Group Ltd; 2015;2015:bcr2015209925–5.

  42. Le Nouail P, Viseux V, Chaby G, Billet A, Denoeux JP, Lok C. DRESS (Drug reaction with eosinophilia and systemic symptoms) après traitement par imatinib (Glivec). Ann Dermatol Venereol. 2006;133:686–8.

    Article  PubMed  Google Scholar 

  43. Valks R, Fraga J, Muñoz E, Bartolomé B, García-Díez A, Fernández-Herrera J. Acute generalized exanthematous pustulosis in patients receiving high-dose chemotherapy. Arch Dermatol Am Med Assoc. 1999;135:1418–20.

    Article  CAS  Google Scholar 

  44. Bracke A, Van Marck E, Lambert J. Acute generalized exanthematous pustulosis after pemetrexed, and recurrence after re-introduction. Clin Exp Dermatol. 2009;34:337–9.

    Article  CAS  PubMed  Google Scholar 

  45. Schwarz M, Kreuzer K-A, Baskaynak G, Dörken B, le Coutre P. Imatinib-induced acute generalized exanthematous pustulosis (AGEP) in two patients with chronic myeloid leukemia. Eur J Haematol. 2002;69:254–6.

    Article  PubMed  Google Scholar 

  46. Wu J, Lee YY, Su SC, Wu TS, Kao KC, Huang CC, et al. Stevens–Johnson syndrome and toxic epidermal necrolysis in patients with malignancies. Br J Dermatol. 2015:n/a–n/a.

  47. Raza S, Kirkland RS, Patel AA, Shortridge JR, Freter C. Insight into Sweet’s syndrome and associated-malignancy: a review of the current literature. Int J Oncol Spandidos Publications. 2013;42:1516–22.

    CAS  Google Scholar 

  48. Kyllo RL, Parker MK, Rosman I, Musiek AC. Ipilimumab-associated sweet syndrome in a patient with high-risk melanoma. J Am Acad Dermatol. 2014;70:e85–6.

    Article  PubMed  Google Scholar 

  49. Assouline S, Laneuville P, Gambacorti-Passerini C. Panniculitis during dasatinib therapy for Imatinib-resistant chronic myelogenous leukemia. N Engl J Med. 2006;354:2623–4.

    Article  CAS  PubMed  Google Scholar 

  50. Ugurel S, Lahaye T, Hildenbrand R, Glorer E, Reiter A, Hochhaus A, et al. Panniculitis in a patient with chronic myelogenous leukaemia treated with imatinib. Br J Dermatol. 2003;149:678–9.

    Article  CAS  PubMed  Google Scholar 

  51. Jagdeo J, Campbell R, Long T, Muglia J, Telang G, Robinson-Bostom L. Sweet’s syndrome–like neutrophilic lobular panniculitis associated with all-trans-retinoic acid chemotherapy in a patient with acute promyelocytic leukemia. J Am Acad Dermatol. 2007;56:690–3.

    Article  PubMed  Google Scholar 

  52. Zimmer L, Livingstone E, Hillen U, Ömkes SD, Becker A, Schadendorf D. Panniculitis with arthralgia in patients with melanoma treated with selective BRAF inhibitors and its management. Arch Dermatol Am Med Assoc. 2012;148:357–61.

    Article  CAS  Google Scholar 

  53. Wiznia LE, Subtil A, Choi JN. Subacute cutaneous lupus erythematosus induced by chemotherapy: gemcitabine as a causative agent. JAMA Dermatol Am Med Assoc. 2013;149:1071–5.

    Article  Google Scholar 

  54. Reinholz M, Berking C, Hermans C, Ruzicka T, Braun-Falco M. Lupus erythematosus–like skin eruption after vemurafenib therapy. J Am Acad Dermatol Elsevier. 2014;71:e159–60.

    Article  Google Scholar 

  55. Evans KG, Heymann WR. Paraneoplastic subacute cutaneous lupus erythematosus: an underrecognized entity. Cutis. 2013;91:25–9.

    PubMed  Google Scholar 

  56. Inaoki M, Kawabata C, Nishijima C, Yoshio N, Kita T. Case of bleomycin‐induced scleroderma. J Dermatol Blackwell Publishing Ltd. 2012;39:482–4.

    Article  Google Scholar 

  57. Yamamoto T, Takagawa S, Katayama I, Yamazaki K, Hamazaki Y, Shinkai H, et al. Animal model of sclerotic skin. I: local injections of bleomycin induce sclerotic skin mimicking scleroderma. J Invest Dermatol. 1999;112:456–62.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, University of Texas Southwestern, 5939 Harry Hines Blvd #300, Dallas, TX, 75235, USA

    Jennifer Gill & Arturo R. Dominguez

Authors
  1. Jennifer Gill
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arturo R. Dominguez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arturo R. Dominguez.

Ethics declarations

Conflicts of interest

Dr. Gill reports personal fees from the University of Texas Southwestern Medical Center, her primary employer, personal fees for travel accommodations from the American Academy of Dermatology, grants from the University of Texas Southwestern, and grants from the National Institutes of Health, outside the submitted work.

Dr. Dominguez reports personal fees from the University of Texas Southwestern Medical Center, his primary employer, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Hospital-based Dermatology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gill, J., Dominguez, A.R. Cutaneous Manifestations of Chemotherapeutic Drugs. Curr Derm Rep 5, 58–69 (2016). https://doi.org/10.1007/s13671-016-0130-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13671-016-0130-0

Keywords

Search

Navigation