Skin-related side effects from cancer treatments can be more than just a cosmetic concern—they can significantly impact a patient’s wellbeing and adherence to therapy. In a detailed interview, Cynthia Ryan, PharmD, BCPS, a clinical oncology specialist at the University of Colorado Hospital Pharmacy, illuminated the important strides being made through the Association of Cancer Care Centers (ACCC)'s initiative focused on supportive care strategies for dermatologic toxicities. This pioneering project is dedicated to improving how healthcare providers, including pharmacists, recognize, prevent, and treat skin toxicities caused by various cancer drugs. By promoting interdisciplinary collaboration and offering practical tools, the ACCC aims to enhance patient quality of life and keep cancer therapies on track without interruptions caused by uncomfortable or disfiguring skin issues.
Dermatologic toxicities present in various ways depending on the anti-cancer agent involved. For instance, immunotherapy commonly causes rashes and itching, which, while sometimes mild, can be distressing or lead to infections if untreated. Liposomal doxorubicin, capecitabine, and oral vascular endothelial growth factor (VEGF) inhibitors often trigger hand-foot syndrome (HFS), a condition characterized by redness, swelling, and pain on the palms and soles, making everyday activities challenging. Epidermal growth factor receptor (EGFR) inhibitors, along with trametinib, frequently cause acneiform rashes that resemble severe acne and mucositis—painful inflammation and ulceration of the mucous membranes. Moreover, alopecia or hair loss remains a widely recognized side effect across many anti-cancer therapies, adding to the emotional burden cancer patients carry. Understanding these agent-specific skin reactions helps clinicians personalize supportive care strategies to each patient’s treatment regimen.
Accurate assessment of these dermatologic adverse events (AEs) is crucial and relies on established clinical tools. The National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE) offers a standardized way to grade the severity of skin toxicities, aiding in consistent communication among healthcare providers. Complementing this, quality of life (QOL) instruments like Skindex-16 allow clinicians to quantify how skin symptoms affect patients’ daily functioning and emotional health. This dual approach ensures that the physical and psychological impact of dermatologic toxicities is not underestimated. Pharmacists, often on the frontline of patient care, can play a pivotal role by utilizing these tools during routine assessments and by facilitating timely referrals to dermatology specialists. With modern electronic health records (EHRs), documenting detailed clinical notes and even photographs of skin reactions enables close monitoring of progression or improvement, which enhances individualized treatment plans.
When it comes to managing these skin side effects, evidence-based strategies can provide significant relief and prevent complications. For example, preventing rash associated with EGFR inhibitors is effectively achieved using hydrocortisone 1% cream, sunscreen, and oral antibiotics such as doxycycline or minocycline during the initial six weeks of treatment. Should a rash develop, medium to high-potency steroid creams combined with continued doxycycline use remain the mainstay. For pruritus or itching, topical steroids and oral antihistamines are first-line, though gabapentinoids may be considered for refractory cases. Hand-foot syndrome prevention includes regular use of urea-containing emollients, while topical diclofenac creams have been shown to reduce the incidence linked to capecitabine. Rash and pruritus caused by immunotherapy also respond to steroids and antihistamines, with escalation to agents like aprepitant in stubborn cases. These nuanced treatment pathways underscore the vital role pharmacists have in educating patients on timely initiation and continuous adherence to these supportive measures.
Beyond management, prevention and education stand out as key pillars in preserving patients’ quality of life and adherence to life-saving cancer therapies. Patients on EGFR inhibitors, for instance, benefit from counseling on gentle skin care habits—washing with tepid water, avoiding perfumed or antibacterial soaps, applying broad-spectrum sunscreen (SPF 30 or higher) regularly, and moisturizing twice daily—to maintain skin integrity. Those at risk for hand-foot syndrome should be advised to steer clear of activities that generate heat and friction on the hands and feet. Most importantly, patients and caregivers must be equipped with clear guidance on recognizing early dermatologic symptoms and understanding when to seek medical attention, especially for rare but serious conditions like Stevens-Johnson Syndrome or toxic epidermal necrolysis. This proactive approach not only improves patient comfort but also significantly supports ongoing cancer treatment adherence by preventing severe interruptions or dose modifications.
Pharmacists, as accessible and knowledgeable healthcare professionals, are central to the successful implementation of these initiatives. They can conduct early and routine toxicity assessments, educate patients and caregivers, coordinate with dermatologists, and leverage patient-reported outcomes (PROs) and electronic health records to monitor side effect progression remotely. In fact, some advanced EHR systems enable patients to upload photos of skin changes, providing real-time information for clinicians to act swiftly. Furthermore, comprehensive educational programs offered by organizations such as the ACCC empower pharmacists to stay abreast of evolving best practices in the management of dermatologic toxicities. This continuous learning ensures that oncology pharmacists serve as vital advocates, mitigating dermatologic complications and fostering sustained adherence to cancer therapies—ultimately contributing to better patient outcomes and quality of life.
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