16
Treatment
Table 1. Cutaneous Toxicities
1.1 Rash/Inflammatory Dermatitis
Workup/Evaluation:
• Pertinent history and physical exam including examination of the oral mucosa,
assessment for blister formation, assessment of body surface area involved.
• Review full list of patient medications to rule out other drug-induced cause for
photosensitivity.
• Rule out any other etiolog y of the skin problem, such as an infection, an effect of
another drug, including prior or other recent cancer therapies, or a skin condition
linked to another systemic disease or unrelated primary skin disorder.
• Recent or new complete blood count and comprehensive metabolic panel (if needed
for skin differential diagnosis).
• Consider referral to dermatologist if autoimmune skin disease is suspected.
• Consider skin biopsy.
• Consider clinical monitoring with use of serial clinical photography.
Grading
Grading according to
Common Terminolog y
Criteria for Adverse Events
(CTCAE) criteria is a
challenge for skin. Instead,
severity may be based on
body surface area (BSA),
tolerability, morbidity, and
duration. Management
G1: Rash covering <10%
BSA, which may or may not
be associated with symptoms
of pruritus or tenderness.
• Continue ICPi.
• Treat with topical emollients and/or mild-moderate
potency topical corticosteroids.
• Counsel patients to avoid skin irritants.
G2: Rash covering 10–30%
BSA with or without
symptoms (e.g., pruritus,
burning, tightness); limiting
instrumental activities of daily
living (ADL); rash covering
>30% BSA with or without
mild symptoms.
• Consider holding ICPi and monitor weekly for
improvement. If skin toxicity not improved after 4
weeks, then re-grade toxicity as Grade 3.
• In addition, treat with topical emollients, oral
antihistamines, and medium-to-high potency
topical corticosteroids.
• Consider initiating prednisone (or equivalent)
at dosing 0.5–1 mg/kg, tapering over 4 weeks. In
patients with pruritis without rash, consider topical
anti-itch remedies (e.g., refrigerated menthol,
pramoxine).
