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Home > St George’s Healthcare Professional Portal > Common Side Effects of Cancer Treatment > Skin rash

Skin rash

Noticeable change in the texture or colour of the skin. Skin may become scaly, bumpy, itchy, or otherwise irritated.

Symptoms might include: redness, scaly skin, bumpy skin, itchy and irritated skin, accompanied by tenderness, sensitivity to touch, tightness of the skin, flaking or peeling of the skin, soreness or severe pain.

Questions

  • What anti cancer therapy is the patient receiving and when was the last treatment?
  • Is the patient receiving any of the following: erlotinib, gefitinib, cetuximab, panitumumab, capecitabine, paclitaxel, docetaxel or immunotherapy?
  • Has the patient received radiotherapy within the last 6 weeks?
  • Has the patient had a stem cell/bone marrow transplant? (graft versus host disease)
  • Has the patient started any new medication including any antibiotics?
  • Does the patient have a history of skin complaints?
  • Where is the skin rash and what does it look like (localized/widespread; flat/raised; ulcer/pustules/peeling/vescicles/bleeding)? Is it itchy?
  • Is the patient otherwise well? Does the patient have any signs of infection?
  • Has the patient been in contact with chicken pox/shingles, recently? Has the patient ever had chicken pox?

Toxicity scale differs for EGFR antagonists

Grade 1 (Green)

Scattered macular or papular eruption or erythema, asymptomatic

Advice

Ensure patient is not neutropenic or thrombocytopenic

Advise:

  • Good fluid intake
  • Avoid hot bath/tight clothes/synthetic fabrics
  • Avoid sun exposure; use sun block and hat
  • Use mild soaps/cleansers/detergents and limit contact with water
  • Hypoallergenic make up and moisturiser
  • Anti-histamine, topical creams and/or lotions

Grade 2 (Amber)

Scattered macular or papular eruption or erythema, with pruritus or other associated symptoms

Advice

Ensure patient is not neutropenic or thrombocytopenic

Advise:

  • Good fluid intake
  • Avoid hot bath/tight clothes/synthetic fabrics
  • Avoid sun exposure; use sun block and hat
  • Use mild soaps/cleansers/detergents and limit contact with water
  • Hypoallergenic make up and moisturiser
  • Anti-histamine, topical creams and/or lotions

Grade 3 (Red)

Generalised  symptomatic macular, papular or vescicular eruption

Advice

Ensure patient is not neutropenic or thrombocytopenic

General advice as per Grade 1 and 2

Analgesia

Interrupt treatment until discussed with Acute Oncology team

Grade 4 (Red)

Exfoliative dermatitis or ulcerating dermatitis

Advice

Ensure patient is not neutropenic or thrombocytopenic

General advice as per Grade 1 and 2

Analgesia

Interrupt treatment until discussed with AOS

Dermatology review

Consider admission for support and further assessment

Handover management with patient’s team, discuss all interruptions of treatment with team +/- AOS prior to proceeding.

Arrange follow up review as necessary.

Initial assessment – patient seen in AOCU

  • Read specific drug information sheet in addition to general guidance
  • Interrupt SACT/chemotherapy including oral chemotherapy drugs, if applicable, until discussed with the Acute Oncology Service Team

Initial assessment

  • Observation: temperature, Pulse, Saturation of Oxygen, respiratory rate. Early Warning Score (nEWS)
  • Investigations: FBC, U&E, CRP

History to include:

  • What chemotherapy is the patient on and when was the last treatment/tablet?
  • See drug specific information sheet
  • Is the patient on any of the erlotinib, gefitinib, cetuximab, panitumumab, capecitabine, paclitaxel, docetaxel or immunotherapy?
  • Is there any other associated symptoms such as diarrhoea, mucositis, temperature?
  • What part of the body is affected?
  • Is the patient able to walk normally? To swipe his/her phone?
  • Any recent new medications?
  • Check bloods (FBC, U&E, CRP, blood cultures if suspecting neutropenic sepsis)
  • Full physical examination

Treatment

  • Assess fluid balance and establish IV access if signs of dehydration or sepsis
  • Treat any infected lesions as appropriate
  • Delineate and record affected areas
  • If ulcers: consider topical acyclovir if on lips or mouth, consider IV acyclovir if haematology patient
  • Anti-histamine for pruritus
  • Pyrexia (T> 38°C) and grade 3 – initiate neutropenic sepsis protocol – do not wait for FBC
  • Topical moisturizing cream/lotion
  • Re-assess daily
  • Dermatology review if any concern
  • Ensure general care measures:
    • Oral intake
    • Keep area clean and dry
    • Avoid hot bath/tight clothes
    • Mild soaps/cleansers/detergents
  • Consider prescribing:
    • Topical creams/lotions
    • Anti-histamines
    • Analgesia
    • Appropriate antibiotics if infected