Skin reactions from targeted therapy deserve attention

Skin reaction from targeted therapy: Caught early, many skin reactions can be treated so that you don’t have to stop targeted therapy.

Are you receiving targeted therapy to treat skin cancer — or any other cancer? If so, dermatologists recommend that you pay close attention to your skin.

Skin reactions are the most common side effect of targeted therapy.

What is targeted therapy, exactly?

When cancer spreads and becomes life threatening, drugs known as targeted therapies may be an option for some patients. Targeted therapy can stop cancer from growing and spreading — at least for a while.

Oncologists (cancer doctors) prescribe target therapy to treat some skin cancers. It may be prescribed to treat melanoma, the most-serious skin cancer, when it spreads. Targeted therapy can also treat basal cell carcinoma (BCC), the most-common skin cancer. It may be prescribed when BCC has spread and surgery or radiation treatments can no longer treat it.

Some patients with dermatofibrosarcoma protuberans (DFSP), a rare type of skin cancer, also receive targeted therapy.

Targeted therapy can give cancer patients remissions that last for months — and sometimes years.

Skin reactions best caught early

Paying close attention to your skin will help you notice the first signs of a skin reaction.

Even if the reaction seems mild, it’s important to tell your dermatologist or oncologist about it. When caught early, most reactions can be managed.

Looking closely at your skin will also help you find a possible new skin cancer early. Although targeted therapies can treat advanced skin cancer, some can cause more skin cancers. Caught early, most skin cancers can be successfully treated.

Early treatment of a skin reaction can also help prevent a worsening reaction. If the skin reaction becomes too severe, a patient may have to stop targeted therapy.

What to look for when receiving targeted therapy for skin cancer

To give you an idea of what you may see, here’s a list of common skin reactions from the targeted therapies approved to treat skin cancer.

Dabrafenib (Tafinlar^®) or vemurafenib (Zelboraf^®) – Prescribed to treat advanced melanoma, the most common skin (and hair) reactions from these drugs are:

• Rash
• Warts or wart-like growths
• Small, rough-feeling bumps, especially on your arms or thighs
• Seborrheic dermatitis
• Sun sensitivity (burn within minutes of being in the sun)
• Blisters and thickening skin on the palms and soles, which can be painful
• Swelling and pain beneath the skin
• Hair loss

More serious skin reactions are:

• A new skin cancer
• New and changing moles, which can become melanoma

Trametinib (Mekinist^®) – This may be prescribed to treat advanced melanoma. Common skin (and hair) reactions that occur while taking trametinib include:

• Rashes, including a measles-like eruption on your skin
• Itchy skin
• Tender, painful, or burning skin
• Extremely dry skin
• Infection around a fingernail or toenail
• Loss of hair color

Ipilimumab (Yervoy^®), nivolumab (Opdivo^®), or pembrolizumab (Keytruda^®) – Patients with advanced melanoma may be prescribed one of these targeted therapies, which can cause the following skin reactions:

• Rash (skin may itch, blister, or develop sores that bleed)
• Extremely dry skin
• Mouth sores
• Itchy skin
• Blisters, crusts, or redness on the skin
• Thick, scaly skin
• Vitiligo (loss of skin color)

Vitiligo on hands: Loss of skin color (vitiligo) while on a targeted therapy usually means treatment is working and you’ll have a good outcome.

Vismodegib (Erivedge^®) – Prescribed to treat advanced basal cell carcinoma, some patients experience the following side effects:

• Hair loss
• Food and beverages taste different
• Skin cancer

Skin care may reduce risk of developing a skin reaction

The right skin care can reduce your risk of developing some skin reactions. If a skin reaction develops, good skin care may lessen your discomfort. That’s why dermatologists recommend the following skin care for patients on a targeted therapy:

1. Keep your skin care gentle and simple. Targeted therapy can make your skin especially sensitive.
   When bathing and washing your hands, the following can help reduce irritated skin:

• Wash with a fragrance-free cleanser made for sensitive skin, and avoid soaps and other skin care products with fragrance.
• Use warm water. Hot water can irritate your skin, so you’ll want to avoid hot tubs, hot baths, and steamy showers.
• Moisturize after washing. Using a fragrance-free moisturizing cream can help reduce dry, irritated skin. For best results, applying the moisturizer within 5 minutes of getting out of the bath or shower or washing your hands.

To keep your skin care gentle, dermatologists also recommend that you:

• Avoid acne products, which can irritate your skin.
• Apply moisturizer (creamy and fragrance-free) throughout the day when your skin feels dry.

2. Avoid the sun. Just a few minutes in the sun can cause a serious burn while you’re on some targeted therapies. You can protect your skin when outdoors — even for a short time — by wearing:

• Long sleeves and pants
• A wide-brimmed hat
• Sunglasses
• Sunscreen (broad-spectrum, SPF 30 or higher, and water resistant)

You want to apply the sunscreen to all skin that clothing won’t cover, such as your face, neck, ears, and hands. A separate lip balm with SPF 30 or higher and water resistance is best for your lips. You’ll want to apply sunscreen and lip balm thoroughly to give yourself good protection.

3. When taking vermurafenib, use UV-light blocking window films. Even sun coming in a window can cause a problem. You’ll want to apply these films to the windows on your car, home, and office.

4. If you develop peeling skin on your hands or feet, take precautions. This side effect can make walking difficult. Wearing comfortable shoes with a wide toe box can reduce the pressure and friction on your feet. When you have peeling on your hands, wearing padded gloves can help reduce discomfort.

5. At the first sign of a skin reaction, contact your doctor. Caught early, many of these reactions can be treated so that they don’t cause a serious problem.

A dermatologist can help you manage skin reactions

Because skin reactions are so common, some patients see a dermatologist before starting targeted therapy. It can be helpful to have a thorough skin exam and get skin care tips beforehand.

If you develop a skin reaction, it’s helpful to have a skin expert to contact for a diagnosis and treatment.

Images
Image of skin reaction: Used with permission of Journal of the American Academy of Dermatology. J Am Acad Dermatol. 2015;72(2):221-36.

Image of vitiligo: Thinkstock

References
Collins LK, Chapman MS, et al. “Cutaneous adverse effects of the immune checkpoint inhibitors.” Curr Probl Cancer. 2016 Dec 14. [Epub ahead of print].

Macdonald JB, Macdonald B, et al. “Cutaneous adverse effects of targeted therapies: Part I: Inhibitors of the cellular membrane. J Am Acad Dermatol. 2015;72(2):203-18.

Macdonald JB, Macdonald B, et al. “Cutaneous adverse effects of targeted therapies: Part II: Inhibitors of intracellular molecular signaling pathways.” J Am Acad Dermatol. 2015 Feb;72(2):221-36.

Patterson S, “Cutaneous reactions to targeted therapy.” Presented during focus session: Update on cutaneous reactions to targeted and immune cancer therapies. 2017 Annual Meeting of the American Academy of Dermatology; 2017 March 3-7. Orlando, FL.

Sibaud, V, Meyer N. et al. “Dermatologic complications of anti-PD-1/PD-L1 immune checkpoint antibodies.” Curr Opin Oncol. 2016;28(4):254-63.