Chemotherapy and the Skin: Understanding Dermatologic Side Effects

TL;DR

This study examines skin side effects from chemotherapy, showing most are mild and manageable, highlighting the importance of early dermatologic care to improve patient outcomes.

Contribution

The study provides a systematic characterization of chemotherapy-induced skin reactions in a referral-based cohort, emphasizing collaborative care for better treatment outcomes.

Findings

Breast carcinoma and gastrointestinal cancers were the most common malignancies associated with chemotherapy-induced skin reactions.

Taxanes, platinum compounds, and antimetabolites were the primary drugs linked to cutaneous adverse drug reactions.

Most reactions were mild (Grade I or II), and supportive dermatologic care led to favorable outcomes without permanent chemotherapy cessation.

Abstract

Background

Chemotherapy-induced cutaneous adverse drug reactions (cADRs) represent a frequent and clinically significant component of treatment-related toxicity in oncology. These reactions may range from mild, self-limiting eruptions to more severe presentations capable of compromising patient comfort, adherence to therapy, and overall quality of life. Their clinical heterogeneity reflects variations in drug class, cumulative exposure, and individual susceptibility. Given the increasing use of combination regimens and targeted therapies, systematic characterization of cADRs remains essential for optimizing supportive care and minimizing treatment interruptions.

Materials and methods

This prospective observational descriptive case series (referral-based cohort) study, which included 30 patients who developed cADRs following administration of single-agent or combination chemotherapy and were subsequently referred from the oncology ward to the dermatology outpatient department (OPD) at a tertiary care center over a one-year period. Demographic, clinical, and treatment-related variables were documented, including latency, morphology, distribution, and severity grading using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Skin biopsies were performed when clinically indicated. Management strategies and clinical outcomes were recorded. Descriptive statistics were used to summarize the data.

Results

Breast carcinoma (33.3%) and gastrointestinal (GI) cancers (23.3%) were the most common underlying malignancies. Taxanes (26.6%), platinum compounds (23.3%), and antimetabolites (20%) accounted for the majority of implicated agents. Predominant cADRs included hand-foot syndrome (HFS) (20%), maculopapular eruptions (16.6%), alopecia (16.6%), nail changes (13.3%), infusion-related urticaria (10%), and pigmentary alterations (6.6%). Most reactions were classified as CTCAE Grade I or II, with only three patients (10%) demonstrating Grade III toxicity. Supportive dermatologic care resulted in favorable outcomes for the majority, and although 20% required temporary dose modification, no patient required permanent cessation of chemotherapy.

Conclusion

Chemotherapy-induced cADRs encompass a broad clinical spectrum, with most reactions being mild to moderate and amenable to timely supportive interventions. Recognition of drug-specific cutaneous patterns and early dermatologic involvement can reduce morbidity, support treatment continuity, and enhance patient satisfaction. Strengthening collaborative care pathways between oncology and dermatology serves an important role in improving overall patient outcomes during systemic cancer therapy.

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