Dermatologic toxicity of chemotherapy.

Abstract

S KIN ERUPTIONS may be caused by many factors in oncology patients. A dermatologic problem may be a simple cosmetic concern or herald severe complications. For example, the skin problem may be simply the exacerbation of a pre-existing skin disease or it may be the result of infection, specific metastatic infiltrates, graft-vs-host disease, other immune phenomenon, a nutritional disorder, or a drug eruption. Although this review specifically concerns chemotherapeutic agents, antibiotics and analgesics are much more likely to cause drug eruptions than are the chemotherapeutic agents. Skin eruptions related to chemotherapy may be the result of direct toxicity on the skin, but may also signal underlying systemic toxicity. It is important to note that some of the chemotherapeutic agents rarely cause skin problems, whereas others are much more likely to cause skin toxicity. The evaluation of a suspected cutaneous drug reaction requires consideration of several factors. This is succinctly reviewed elsewhere.‘y2 Most drug eruptions are nonspecific, the most common type of reaction being a disseminated exanthem (morbilliform eruption). Unfortunately, package inserts and literature references often refer to skin eruptions as nonspecific “skin rashes.” Immunologic reactions constitute a minority of all drug eruptions, with nonimmunologic causes accounting for least two thirds of all cutaneous drug reactions. This would certainly appear to be the case with chemotherapeutic agents, in which most reactions are likely to occur because of the direct toxicity of the drug on the skin and its appendages. This review will provide an overview of major specific cutaneous reaction patterns associated with chemotherapeutic agents. A number of more extensive reviews serve as excellent additional references.3-6 The major patterns of skin toxicity from chemotherapy include stomatitis, alopecia, hyperpigmentation, nail disorders, interactions with radiation and ultraviolet light, extravasation injury, and hypersensitivity reactions. Some interesting additional reactions are specific to certain drugs.