Skin rashes from monoclonal antibody therapy or chemotherapy drugs affect more than skin. They can present as an ugly, full-scale popular and painful rash affecting one socially and emotionally.

Patients often experience these rashes while taking the newer biologic drugs such as erlotinib, pantumumab, cetuximab, imatnib, pantiumumab, cetuximab, imatinib and gefitinib (see drugs listed below). While these drugs are exciting and welcomed by patients and physicians, they add another dimension of visible toxicities that patients may endure.

Rashes from monoclonal antibody drugs result from over-depression of epidermal growth factor receptor inhibitors as they interrupt tumor growth. Often, rashes are a sign of favorable cellular and chemical events. Chemotherapy agents such as docetaxel, capecitabine, and gemcitabine and pacitaxel liposomal also can cause skins eruptions and rashing.

Given these “necessary evils”, patients must manage the rash – both physically and emotionally.

Disfiguring and Disabling

Although some newer monoclonal antibody therapies may not cause physical side effects such as neutropenia, fatigue or anemia, facial and chest lesions can be so embarrassing that they may keep the patient isolated. Hands and fingers may also be cracked that makes self care difficult. Wearing clothes can be uncomfortable. Staying active and involved with family and friends may be challenging, and depression and anxiety can increase.

Symptoms

Rashes can cause generalized erythematous, maculo-papular rash causing significant discomfort and itching. Most rashes begin 7-10 days from the start of treatment and peak at 2 weeks.

Treatment

• Metronidazole may help.
• Support from family and friends
• The physician may have provided prophylactic treatment with tetracyclines to prevent disfiguring acne.
• Avoid sun and heat
• Wear protective clothing
• Use sunscreen of at least SPF 15 (may be uncomfortable or more damaging if skin is already irritated)
• Take good care of hands and nails.
• Use medications to relieve itching:
  -Hydroxyquinoline sulfate 0.3% (antiseptic) in a petrolatum and lanolin (bag balm)
  -Vitamin A&D ointment
  -Pimecrolimus cream (Elidel)
  -Topical antihistamine cream (Benadryl)
  -Glycerine soaps, creams and lotions
  -Metronidazole cream
  -Antihistamines/antiobiotics

Precautions

• Sunlight and wind will exacerbate symptoms
• Avoid using moisturizes with retinol, products containing alcohol or soap on the face.
• Avoid manicures or pedicures – which may cause infections.

Nursing Responsibility

• Monitor the rashes, notify the physician, occasionally a rash may signal toxicity of the drug.
• Document, report and grade skin rashes
• Education regarding the potential reaction should be given prior to administration of the drug.

DRUGS that can cause significant rashes

• Capecitabine (Xeloda)
• Cetuximab (Erbitux)
• Dasatnib (Sprycel)
• Docetaxel (Traxotere)
• Erlotinib (Tarceva)
• Gefitinib (Iressa)
• Gemcitabine (Gemzar)
• Imatinib (Gleevec)
• Lapatnib (Tykerb)
• Panitumumab (Vectibix)
• Paclitaxel Liposomal (Abraxane)
• Rituximab (Rituxan)
• Sorafenib (Nexavar)
• Sunitinib (Sutent)