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Skin Changes Caused By Targeted Chemotherapies

What kind of skin changes can targeted therapies cause?

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© American Cancer Society 2010

Rash

The most common skin change is a rash. The risk of getting the rash and how bad it is depends on the type of cancer and the type and dose of the targeted therapy drug used to treat it.

The rash is mild for most people. It often looks a lot like acne and shows up on the scalp, face, neck, chest, and upper back. In severe cases it can affect other parts of the body.

The rash most often starts as skin redness and swelling and is often worst within the first few weeks of treatment. By about the 4th week of treatment, the skin usually crusts and gets very dry and red. In the weeks after that, round, flat or raised red spots and pimples with pus in the center often appear. The rash can be itchy. It may get better or stay about the same during the rest of treatment, but it should completely go away about a month after treatment is stopped.

The rash can be very distressing and cause self-esteem problems. It may be painful and may lead to infections. Prevention and treatment are discussed in the next 2 sections.

Dry skin

The skin can become very dry and scaly and may even crack open. This can happen on its own or with the rash. When it happens with the rash it tends to be worse.

Itching

Many of the skin changes, like rash or dryness, can cause itching. Steps to prevent and treat skin changes, as discussed below, can help with itching. Some people may need to take medicine by mouth, such as diphenhydramine (Benadryl ®), to get relief.

Red, sore cuticles (the areas around the fingernails)

Some targeted therapies may cause swollen, red, open, and painful skin sores around the fingernails and toenails. (This can look a lot like an ingrown nail.) This most often happens to the big toes and thumbs. These sores may become infected. Nails may also become brittle and grow more slowly.

Hand-foot syndrome

Hand-foot syndrome (HFS) has been linked to many cancer treatment drugs, including some targeted therapies. The cause of this syndrome is not known for sure. It may have to do with damage to the tiny blood vessels in the hands and feet, or with the drugs themselves leaking out of the blood vessels and causing tissue damage.

A painful sensitivity of the hands and feet is the earliest symptom of HFS. Then, redness and swelling start in the palms of the hands and the soles of the feet. This redness looks a lot like sunburn and may blister. In severe cases, the blisters can open up and become sores. The affected skin also can become dry, peel, and crack. It may burn, tingle, or feel numb.

HFS can be painful and can affect your ability to walk and carry out normal activities. If it becomes severe, pain medicines may be needed. It is important to let your doctor know if you are having any symptoms of HFS -- even if they are mild. Treating HFS early can help prevent severe cases. Like the other skin changes discussed, it can be treated, and there are things you can do to try to prevent it. These are reviewed in the next section.

Changes in hair growth

Hair on your head can become thin, dry and brittle, or even curly. Long-term use of targeted therapy may lead to complete loss of scalp hair.

Facial hair for both men and women may grow faster than usual, including longer, thicker, curly eyelashes that may need to be trimmed. These changes usually do not happen right away, but you may notice them later as treatment goes on.

Changes in hair or skin color

Some of the newer drugs can cause the skin or hair to turn a yellowish color during treatment. This typically goes away once treatment is finished.

Other side effects

Many other less common side effects have also been linked to treatment with targeted therapies. These include the following:

  • diarrhea
  • nausea and vomiting
  • constipation
  • mouth sores
  • shortness of breath
  • cough
  • feeling tired all the time (fatigue)
  • headache
  • swelling in your hands and feet
  • high blood pressure

Your health care team will watch you closely during treatment and will check your blood counts often. Side effects can and should be treated as early as possible. It is important that you tell your health care team about any changes in how you feel or anything you notice that is new or unusual. Tell them right away so they can treat any problems and try to keep them from getting worse.


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