Skin toxicities in cancer patients can be reduced with early care

Early treatments of skin toxicities caused by treatments for cancer can help improve treatment outcomes and reduce possible disruptions of cancer therapy. Pretty well every anti-cancer treatment can lead to skin reactions, and while most are relatively mild they can cause a lot of distress in patients, said Dr. Maxwell Sauder, an assistant professor of medicine at the University of Toronto and an onco-dermatologist at Princess Margaret Cancer Centre. He spoke at the Canadian Dermatologic Association (virtual) annual meeting. At the same time, “skin reactions often can indicate that a patient is responding to the cancer treatment,” he said. But at the other end of the spectrum, some cancer-related skin toxicities can be so severe they are life-threatening or can lead to a pause or reduction in cancer treatment. Indeed, it has been found that over 50% of cancer patients experience a treatment interruption due to dermatologic adverse events that can ultimately lead to treatment discontinuation. Cancer treatments cover a wide gamut and include surgery, radiation, transplantation, traditional chemotherapies, targeted therapies, immunotherapy, and hormonal therapies, and each can have potential effects on the skin. “They can all result in inflammatory reactions of the skin and can even change the skin’s physiology,” he told The Medical Post in an interview. Some treatments are associated with specific dermatologic problems, but others such as dryness or hair loss are common with most therapies. He noted several examples of treatments and associated skin problems. Chemotherapy is associated with several skin conditions the most common being anagen effluvium or abrupt hair loss. It can also lead to xerosis, thrombophlebitis, pruritis and more. Read: Skin across the spectrum: Dermatology education resources turn attention to caring for people with skin of colour “Up to 40% of patients undergoing chemotherapy present with cutaneous adverse reactions,” he said. Between 30% to 40% of cancer patients undergo radiotherapy, and skin changes from this occur in up to 95% of patients. Radiation dermatitis occurs in about 87% of breast cancer patients and 90% of patients with head and neck cancers. Reactions in the skin are limited to the irradiated area but also can be aggravated by concurrent anti-cancer therapies. Radiation dermatitis is categorized as acute, meaning it occurs within one to four weeks of treatment, or chronic where skin problems from it appear after four weeks after treatment or can even develop years after treatment. Targeted therapies are associated with skin reactions ranging from hand-foot skin reaction which presents with thickened red skin over pressure points; pruritus; acne-like rashes and other issues. With immunotherapy, common problems are pruritus, vitiligo and other inflammatory presentations such as lichenoid, psoriasiform or eczematous eruptions which can occur any time during treatment course, and may continue long after treatment is stopped. Read: Non-melanoma skin cancer rates up 30% in Ontario from 2003 to 2017 Importantly, these dermatologic issues such as rashes, scaling, dryness, scarring, and acne-like flare-ups “can impact patient activities of daily living, psychological health, and self-image,” Dr. Sauder said. One study reported that 67% of patients reported that dermatologic adverse effects from cancer treatments were worse than they initially believed. Close to 69% of patients who develop dermatologic issues feel significantly limited in their daily activities “More than half of patients, 58%, rate chemotherapy-induced alopecia as the most traumatic side effect, with a significant number, 8%, saying they would decline chemotherapy because of hair loss,” he said. Another study from 2003 reported that scars resulting from oncologic surgical procedures lead to psychologic problems in 15% of survivors of childhood cancers. Importantly, these dermatologic issues such as rashes, scaling, dryness, scarring, and acne-like flare-ups “can impact patient activities of daily living, psychological health, and self-image,” Dr. Sauder said. One study reported that 67% of patients reported that dermatologic adverse effects from cancer treatments were worse than they initially believed. Close to 69% of patients who develop dermatologic issues feel significantly limited in their daily activities. “More than half of patients, 58%, rate chemotherapy-induced alopecia as the most traumatic side effect, with a significant number, 8%, saying they would decline chemotherapy because of hair loss,” he said. Another study from 2003 reported that scars resulting from oncologic surgical procedures lead to psychological problems in 15% of survivors of childhood cancers. Preventative skincare reduces cutaneous effects of cancer treatments On the bright side, many skin complications can be reduced in severity or even potentially avoided, with early preventative skincare, Dr. Sauder said. To help healthcare workers who see cancer patients, Dr. Sauder along with other dermatologists and oncologists developed the Canadian Skin Management in Oncology (CaSMO) Algorithm. It is designed to help patients with oncology treatment-related skin toxicities. Recently published, this and related documents address prevention, as well as treatment strategies, and are available online in the Skin Therapy Letter. The CaSMO algorithm, stated “The current CaSMO algorithm is designed as a first in a series and focuses on general skincare measures for cancer-treatment-related skin toxicity prevention and management. The clinical algorithm is easy to apply also by non-dermatologists.” Before cancer treatment even begins, a discussion should be had with the patient which includes educating them about cancer treatment-related skin toxicities. Preventative care strategies should be addressed in some detail. If available, a dermatologist can be brought onto the patient’s cancer care-team. Patients should start a daily skin routine starting as early as possible, before treatment starts. The basic parts are: hygiene (cleaning with mild temperature water with a gentle cleanser that has pH similar to that of the skin of 4.0-6.0); moisturize (hypoallergenic moisturizer daily over the whole body), sun protection (apply sunblock of SPF 30 or higher when outdoors rain or shine). Skincare education should address general measures such as avoiding skin irritants, scented products, temperature extremes, sun avoidance, and using sun-protective clothing such as wide-brimmed hats and sunglasses. The effect of this routine on the skin is “has been shown to delay onset of skin complications and reduce severity,” Dr. Sauder said. After treatment starts, skincare routines need to continue. Patients should be encouraged to report any changes in thein after cancer treatment starts. If any changes are mild, then the regular skincare routine should continue. More serious reactions can include blisters, fever, skin pain, mucosal involvement or show significant lab abnormalities which can be potentially life-threatening and should be evaluated promptly. Any skincare products being used by cancer patients should have formulations that are safe, effective, and free of allergens and irritants such as common preservatives causing allergy, fragrances, and perfumes, said Dr. Sauder. Read: Evidence for cannabis products in dermatology only skin deep

Skin toxicities in cancer patients can be reduced with early care

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