What are the treatment options for chemotherapy-induced rash (chemo rash)?

From the Guidelines

Chemotherapy-induced rash should be treated with a multi-faceted approach, including gentle skin care, topical corticosteroids, and oral antihistamines, with the goal of reducing inflammation, preventing further irritation, and improving quality of life. According to the most recent and highest quality study 1, the management of cutaneous side effects includes topical and systemic corticosteroids, antibiotics, topical urea, salicylic acid, and oral isotretinoin. For mild rashes, gentle skin care is recommended using fragrance-free moisturizers like CeraVe or Eucerin applied multiple times daily, along with lukewarm showers using mild soaps such as Dove or Cetaphil. Topical corticosteroids like 1% hydrocortisone cream can be applied to affected areas 2-3 times daily for up to two weeks to reduce inflammation.

For moderate to severe rashes, prescription-strength corticosteroids such as triamcinolone 0.1% or medications like pimecrolimus (Elidel) may be needed. Oral antihistamines like cetirizine (10mg daily) or diphenhydramine (25-50mg every 6 hours) can help control itching. For acneiform rashes specifically from EGFR inhibitors, topical clindamycin 1% solution twice daily and/or oral doxycycline 100mg twice daily for 2-4 weeks may be prescribed. It's essential to avoid sun exposure by using broad-spectrum sunscreen (SPF 30+) and wearing protective clothing, as chemotherapy can increase photosensitivity.

The study also suggests that cooling of hands and feet during infusions, as well as the use of topical high-potency steroids and oral dexamethasone, can be effective in managing palmar-plantar erythrodysesthesia syndrome (PPES) 1. Additionally, lidocaine 5% cream or patches may be used for analgesia on painful areas in feet and hands. It is crucial to contact the oncologist if the rash is severe, painful, blistering, or accompanied by fever, as dose adjustments of chemotherapy or additional treatments may be necessary. The management of chemotherapy-induced rash should be tailored to the individual patient's needs, taking into account the severity of the rash, the type of chemotherapy being used, and the patient's overall health status.

From the FDA Drug Label

Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema psoriasis poison ivy, oak, sumac insect bites detergents jewelry cosmetics soaps seborrheic dermatitis Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily

Treatment for chemo rash may include the use of hydrocortisone (TOP) to relieve itching associated with skin irritations, inflammation, and rashes.

• Apply to the affected area not more than 3 to 4 times daily for adults and children 2 years of age and older.
• For children under 2 years of age, or under 12 years of age for external anal and genital itching, ask a doctor 2 2

From the Research

Treatment for Chemo Rash

• The treatment for chemo rash is crucial to improve the quality of life and clinical outcomes of patients undergoing chemotherapy 3.
• According to a study, the prevalent cutaneous side effects in patients undergoing chemotherapy include skin rash, xerosis, pruritus, paronychia, hair abnormality, and mucositis 3.
• Guidelines for the management of skin rash in patients on chemotherapy and targeted therapy are essential to ensure high-quality care, but the quality of these guidelines varies greatly 4.
• A systematic appraisal of guidelines for the management of skin rash in patients on chemotherapeutic drugs and targeted anticancer therapies found that only two guidelines were classified as "recommended" 4.
• Recognition and management of cutaneous reactions to chemotherapy are important to provide optimal care, and most of the toxicity is reversible with chemotherapy dose reductions or delays 5.
• Certain toxicities can be effectively treated or prevented, allowing optimal delivery of chemotherapy, such as premedications to prevent hypersensitivity and prophylactic mouthwashes to prevent mucositis 5.
• Prophylactic minocycline has been shown to reduce the development of all-grade and grade 1 acneform rash in patients who received erlotinib, and prophylaxis with pyridoxine 400 mg in capecitabine-treated patients lowered the risk of grade 2 or 3 hand-foot syndrome 6.
• Scalp cooling significantly reduced the risk for severe hair loss or total alopecia associated with chemotherapy 6.

Management of Skin Toxicity

• The management of skin toxicity associated with chemotherapic agents is necessary for suitable drug administration and to improve quality of life and clinical outcomes 3.
• Cutaneous toxicity occurs frequently with chemotherapy and non-chemotherapeutic biologic therapies, and early recognition and treatment of the toxicity facilitates good symptom control, prevents treatment-related morbidity, and allows continuation of anti-cancer therapy 5.
• Chemotherapy-related cutaneous toxicity includes generalized rashes, site-specific toxicity such as mucositis, alopecia, nail changes, extravasation reactions, or hand-foot syndrome 5.
• Newer non-chemotherapeutic targeted therapies such as epidermal growth factor receptor inhibitors may also be associated with cutaneous toxicity and can be distressing for patients 5.
• Recent data suggest that skin toxicity associated with these agents may correlate with efficacy 5.