From the Guidelines
To manage taxane-induced dermatitis, it is recommended to follow a graded approach based on the severity of the reaction, with interventions ranging from behavioral aspects and skin care for prevention, to topical high-potency steroids and oral dexamethasone for treatment, as outlined in the ESMO clinical practice guidelines 1.
Prevention and Treatment Strategies
For the prevention of taxane-induced dermatitis, particularly palmar-plantar erythrodysesthesia syndrome (PPES), behavioral aspects and skin care are crucial, including avoiding irritation to the hands and feet, and using urea 10% cream at least twice daily 1. Cooling of hands and feet during infusions is also recommended to reduce the frequency and severity of PPES.
Graded Treatment Approach
- For Grade 1 treatment, continuing the drug at the current dose and monitoring for changes in severity, along with cooling of hands and feet during infusions and topical high-potency steroid twice daily, is advised 1.
- For Grade 2 treatment, the approach includes continuing the drug at the current dose, cooling of hands and feet, topical high-potency steroid twice daily, and oral dexamethasone (8 mg twice daily for 5 days, then tapered) 1.
- For Grade 3 or intolerable Grade 2 treatment, interrupting treatment until the severity decreases to Grade 0-1, and continuing treatment of the skin reaction with cooling, topical high-potency steroid, and oral dexamethasone is recommended 1.
Additional Considerations
Lidocaine 5% cream or patches may be used for analgesia on painful areas to enable activities of daily living 1. Pyridoxine is not recommended for the prevention of PPES due to lack of benefit in well-designed randomized studies 1. Celecoxib has shown potential in preventing PPES induced by certain chemotherapies but should be used with caution due to potential adverse effects and unclear interactions with tumor response 1.
From the Research
Management of Taxane-Induced Dermatitis
There are no research papers provided that directly address the management of taxane-induced dermatitis. However, the studies provided offer insights into the treatment of dermatitis and eczema, which may be relevant to managing taxane-induced dermatitis.
Topical Corticosteroids
- Topical corticosteroids have been the mainstay of treatment for atopic dermatitis (AD) over the last decade 2, 3.
- They have a nonspecific anti-inflammatory effect, which is thought to be primarily a result of their action on the chemical mediators of inflammation 3.
- However, heavy and prolonged use of topical corticosteroids is undesirable due to side effects such as skin atrophy, telangiectasia, and steroid-induced dermatoses 2, 4.
Alternative Treatments
- Topical calcineurin inhibitors, such as pimecrolimus, are a viable alternative to topical corticosteroids in treating dermatitis of the face, neck, eyelids, and intertriginous areas 2, 5.
- Medical device emollients have also been shown to be effective in treating mild-to-moderate AD, with anti-oxidant, anti-protease, and anti-inflammatory activity 2.
- Proactive therapy with twice weekly use of topical corticosteroids and calcineurin inhibitors in previously affected areas has been found to reduce the time to the next eczematous flare 5, 6.
Considerations for Treatment
- The choice of treatment should take into account the severity of the dermatitis, the location of the affected area, and the potential for side effects 3, 6.
- Mild-potency topical corticosteroids may be sufficient for mild dermatitis, while moderate- or potent-potency topical corticosteroids may be necessary for more severe cases 6.
- The use of topical corticosteroids should be carefully monitored to minimize the risk of side effects, particularly in sensitive skin areas like the face 4.