Cutaneous Reactions To Chemo and Radiotherapy
Cutaneous Reactions To Chemo and Radiotherapy
Cutaneous Reactions To Chemo and Radiotherapy
OF CHEMO AND
RADIOTHERAPY
BY DR MAJID KHAN
OUTLINE
• Toxic erythema of chemotherapy
• Papulopustular eruptions
• Chemotherapy‐induced hair changes
• Chemotherapy‐induced nail changes
• Chemotherapy‐induced hyperpigmentation
• Chemotherapy‐induced hypopigmentation
• Photosensitivity
• Recall reaction
• Radiotherapy‐associated skin side effects
•Commonly affected areas: palms, soles, major flexures.
• Papulopustular eruptions are drug-induced acneform dermatoses resembling acne vulgaris but
typically lacking a comedonal component.
• Also referred to as acneform eruptions.
• Incidence: Can occur in up to 90% of patients receiving EGFR inhibitors
Pathophysiology
• Caused by the inhibition of signal transduction pathways by targeted agents like EGFR
inhibitors.
• EGFR inhibition leads to premature differentiation of keratinocytes and subsequent
inflammatory responses.
Clinical Features
• Presentation within the first two weeks of treatment with symptoms like burning pain, pruritus.
• Lesion distribution: scalp, face, chest, back, extremities; lacks comedones.
Severity Classification
• CTCAE grading scale: Classifies severity based on the extent of body surface area affected and associated
symptoms.
• MASCC grading scale: Specific to EGFR inhibitor-induced toxicities.
Disease Course & Prognosis
• Severity can vary, with monoclonal antibodies causing more severe reactions.
• Typically resolves within two months post-treatment without scarring; potential for post-inflammatory
hyperpigmentation.
Differential Diagnosis
Coping Strategies
• Psychological support, counseling, and options like wigs or head coverings.
• cooling caps as a preventive measure. Note that there are no specific medications, but
minoxidil can help regrow hair.
CHEMO INDUCED HYPERTRICHOSIS
• Commonly associated with EGFR inhibitors.
• Manifests as facial hypertrichosis, changes in hair texture, and eye hair alterations.
Pathophysiology
• EGFR's role in regulating the hair growth cycle.
• Impacts the anagen phase of hair growth, resulting in changes during chemotherapy.
Clinical Features
• Hair texture, length, and thickness alterations during EGFR inhibitor treatment.
• Trichomegaly complication: Eyelash growth towards the eye, causing abrasions.
• Differential Diagnosis & Prognosis
• Differential diagnosis includes paraneoplastic hypertrichosis.
• Typically reversible hair changes within a month post-treatment cessation.
• Investigations & Management
• No specific investigations required for diagnosis.
• Management involves discontinuation of the responsible drug.
• Facial hirsutism management through temporary or permanent hair removal methods like
topical eflornithine or laser hair removal.
CHEMO INDUCED NAIL CHANGES
Investigations
• Clinical history and timing are often diagnostic; biopsy or skin swab if diagnosis is uncertain or infection is
suspected.
Management
• No evidence for preventive treatments; basic hygiene and emollients are initiated.
• Grades 1-3: Clean, dry, and topical applications including antiseptic creams, hydrophilic dressings, and moderate to
strong topical steroids.
• Integrated care approach involving oncologists, nurses, and dermatologists; regular assessment.
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