P36-7 Importance of checking tinea infections before tyrosine kinase inhibitor treatment

Abstract

Tyrosine kinase inhibitors (TKIs) are used to treat unresectable carcinoma can have adverse effects such as hand-foot skin reactions (HFSR) with symptoms on the palms and soles such as peeling, erythema, and pain. In this study, we report two cases in which suspected HFSR symptoms were caused by tinea infections. As nurses provide self-care support to patients starting TKI treatment, this report will help support patients' effective self-care. This study was approved by the Ethical Committee of the Graduate School of Nursing, Chiba University, Japan. A male patient aged 70 years had erythema on both soles by day 9 after starting the TKIs lenvatinib. By day 20, he had peeling and annular erythematous on the dorsal surface of both ankles, and his dose of lenvatinib was therefore reduced. His symptoms worsened and improved repeatedly, and when ulceration between toes was observed, he was referred to a dermatologist who diagnosed a tinea infection. A second male patient, aged 78 years, had ulcers from his left ankle joint to the dorsum by day 8 of treatment with the TKIs regorafenib, and he missed his treatment due to suspicion of side effects caused by the TKIs. When his symptoms worsened without treatment, he consulted a dermatologist and was diagnosed with a tinea infection. Although the application of steroid ointment is recommended when HFSR occurs, it is important to differentiate between HFSR and tinea infections because steroids can make tinea infections worse. HFSR and tinea infections have much in common, such as peeling and the tendency to develop in feet, and it can be difficult to differentiate them by visual examination and questioning alone. The nurses should observe the patients' feet before TKIs treatment and recommend consultation with a dermatologist if tinea infections are suspected.