Management of skin adverse reactions in oncology

Chemo and targeted anticancer therapies present significant skin adverse reactions, which impair the patients’ quality of life. Cutaneous toxicities lead to poor treatment adherence, drug cessation, and psychosocial distress. This review aims to summarize the current knowledge concerning the prevention and management of skin toxicity arising from these therapies. A systematic literature search on online databases was conducted. The categorization of the main preventive and treatment measures was performed according to the level of evidence. Management of skin adverse reactions of oncology treatments is very heterogeneous, which can be explained by the lack of sound evidence-based treatments. The most studied adverse effects are papulopustular eruption, xerosis, and hand–foot syndrome. Prevention of xerosis stands out as the strategy most supported by level II studies. With respect to treatment, the use of antibiotics in papulopustular eruption resulting from anti-epidermal growth factor receptor agents is the most evidence-based approach. In general, the number of studies published in the literature classified with a level II of evidence (52%) is similar to the ones classified as level IV (33%), making clear the need of more randomized controlled trials regarding the effectiveness of preventive and treatment measures of skin adverse reactions of chemo and targeted anticancer therapies.

Challenges and Advances in Rosacea Management

Rosacea is a common chronic inflammatory disorder characterized by symptoms of facial flushing and spectrums of clinical signs, including erythema, dry skin, and an inflammatory papulopustular eruption with periods of exacerbation. The current classification system developed by the National Rosacea Society Expert Committee consists of erythematotelangiectatic, papulopustular, phymatous, and ocular subtypes. Individual subtypes are likely a result of different pathogenic factors and respond best to different therapeutic regimens. Before initiation of therapy, the triggering factors should be identified and avoided. Daily applied sunscreen is a must. The main treatment modalities for rosacea include topical, systemic, laser, and light therapies. Traditional therapies include topical metronidazole or azelaic acid also oral therapy as tetracyclines or isotretinoin. Emerging therapies perhaps are more promising as topical ivermectin 1% cream which is proved to be safe and effective for the treatment of inflammatory lesions from papulopustular rosacea, Brimonidine tartrate and oxymetazoline are novel therapies to treat the erythema associated with rosacea. Other treatments as pimecrolimus 1% cream, clindamycin phosphate 1.2% + tretinoin 0.025% gel, pulsed dye laser and intense pulsed light can also be used. With the advent of novel therapeutic options for the treatment of rosacea such as subantimicrobial anti-inflammatory dose doxycycline, ivermectin and Brimonidine tartrate, there is renewed interest in the study of this disease which was once regarded as a debilitating disorder and now has become a well-known and manageable entity in the setting of these emerging therapeutic options. Herein, we describe the treatments currently available as well as the emerging and combination therapies.