Can carboplatin (carboplatin) cause skin rash?

Carboplatin and Skin Rash

Yes, carboplatin causes skin rash in approximately 2% of patients as a hypersensitivity reaction, manifesting as rash, urticaria, erythema, or pruritus, according to FDA labeling data. 1

Types of Skin Reactions Associated with Carboplatin

Carboplatin-related skin manifestations occur through two distinct mechanisms:

Allergic Hypersensitivity Reactions (Most Common)

• Skin rash occurs as part of true IgE-mediated allergic reactions in 2% of patients, presenting with rash, urticaria, erythema, and pruritus 1
• These allergic reactions are similar in nature and severity to other platinum-containing compounds and can progress to anaphylaxis 1
• Hypersensitivity reactions occur in 1-46% of patients overall, with symptoms including rash, edema, hives/itching, and other systemic manifestations 2
• The incidence increases dramatically with repeated exposures—from 1% in patients receiving ≤6 infusions to 27% after >15 infusions, with peak incidence at the 8th or 9th exposure 2

Infusion-Related Reactions

• Mild infusion reactions can present with flushing and rash, which typically resolve quickly after stopping the infusion 2
• These reactions differ from true allergies as symptoms improve rapidly once the infusion is discontinued 2

Critical Risk Factors for Developing Rash

The following patients face higher risk:

• Those receiving carboplatin as second-line treatment after recurrence (typically cycles 7-9 of total exposure) 2
• Patients with prior platinum exposure or drug allergies 2
• Those with BRCA1/BRCA2 mutations appear to have elevated risk 3

Clinical Presentation and Timing

Carboplatin-induced rash typically occurs:

• Within minutes or during the infusion itself 2
• Rarely after the first 6 cycles—most reactions occur after cycle 7 or later 2
• Can occur days after infusion in some cases 2

Management Algorithm When Rash Develops

For Mild Rash (Flushing, Localized Rash Without Systemic Symptoms)

• Stop the infusion immediately and maintain IV access 2
• Administer H1-antihistamines for symptomatic treatment 2
• Consider restarting at a much slower infusion rate if patient, physician, and nursing staff are comfortable 2
• Do not rely on premedication alone—corticosteroids and antihistamines do not prevent recurrent HSRs or anaphylaxis in sensitized patients 2

For Moderate to Severe Reactions (Widespread Urticaria, Hives, Systemic Symptoms)

• Stop infusion immediately and do not restart 2
• Administer combined H1/H2 antihistamines (diphenhydramine 50 mg IV plus ranitidine 50 mg IV) 4
• Give corticosteroids (methylprednisolone 1-2 mg/kg IV every 6 hours) 4
• For anaphylaxis: epinephrine 0.01 mg/kg (maximum 0.5 mg) IM into lateral thigh is first-line treatment 4

For Future Treatment Decisions

• Consult allergist and perform skin testing before next cycle to confirm true allergy versus infusion reaction 2
• Skin testing uses non-irritating concentrations: 10 mg/mL skin prick, then 0.1 mg/mL and 1 mg/mL intradermal (maximum 5 mg/mL intradermal to avoid local necrosis) 2
• If skin test is positive and carboplatin remains the preferred therapy, implement desensitization protocol 2, 3
• If patient had severe life-threatening anaphylaxis, carboplatin should never be used again 2

Important Caveats and Pitfalls

Common mistakes to avoid:

• False-negative skin tests occur in 8-8.5% of cases, particularly if testing is performed <6 weeks after the reaction 2
• Repeat skin testing should be considered if initial test is negative but clinical history is strongly suggestive 2
• Premedication with steroids and antihistamines does NOT prevent HSRs and should not be relied upon as sole prevention strategy 2
• Patients with mild prior reactions to carboplatin can develop more serious reactions even with slow infusion, requiring allergist consultation 2

Cross-Reactivity Considerations

If carboplatin must be discontinued due to rash/allergy:

• Cross-reactivity with cisplatin is 7% 2, 3
• Cross-reactivity with oxaliplatin is 37% 2, 3
• Cisplatin represents the safest alternative platinum agent for carboplatin-allergic patients 2, 3