Dermatologic Toxicity Research Articles

BackgroundDermatologic toxicities are common among metastatic colorectal cancer (mCRC) patients receiving epidermal growth factor receptor inhibitors (EGFRIs), adversely affecting their well-being and quality of life (QoL). Currently, no validated tool exists in China to measure these symptoms. This study validated the Simplified Chinese version of the Functional Assessment of Cancer Therapy–EGFRI 18 (FACT-EGFRI-18-sC) for QoL assessment in mCRC patients.MethodsA cross-sectional study was performed via convenience sampling to recruit mCRC patients from two tertiary hospitals in Shenyang, China. Sample size adequacy was confirmed by post hoc power analysis (G*Power 3.1; >80% power for r ≥ 0.3, α = 0.05). Acceptability was assessed by item-level missing data. Reliability was evaluated by Cronbach’s α and a 2-week test–retest intraclass correlation coefficient (ICC). Criterion validity was evaluated against the Simplified Chinese version of the patient-reported version of CTCAE (PRO-CTCAE-sC) through non-parametric analyses. Construct validity was assessed via correlations with the Simplified Chinese Body Image Scale (BIS-sC), Karnofsky Performance Status (KPS), and cetuximab cycles using Spearman tests. Diagnostic accuracy and cutoff value were determined via receiver operating characteristic (ROC) analysis.ResultsThe final sample (n = 184) provided sufficient statistical power, with post hoc analysis revealing 98% power (α = 0.05) to detect correlations exceeding 0.3. The FACT-EGFRI-18-sC showed excellent acceptability (no missing data) and satisfactory reliability (Cronbach’s α = 0.899, ICC = 0.875). Moderate to strong negative correlations with PRO-CTCAE-sC (r = -0.436 to -0.803, p < 0.001) and significant FACT-EGFRI-18-sC score differences by dermatologic toxicity status (Z = -4.823 to -7.457, p < 0.001) supported criterion validity. Scores of the FACT-EGFRI-18-sC correlated negatively with BIS-sC (r = -0.565 to -0.619, p < 0.001), positively with KPS physical/functional subscales (r = 0.424/0.541, p < 0.001), but not with the social/emotional subscale (r = 0.125, p > 0.05), confirming construct validity. ROC analysis yielded an area under the curve (AUC) of 0.844 and identified an optimal cutoff of 60.00.ConclusionsThe validated FACT-EGFRI-18-sC is a robust tool for QoL assessment in mCRC patients experiencing EGFRI-related dermatologic toxicities, providing a standardized measure to guide toxicity management.

Enfortumab vedotin-ejfv (EV), an antibody-drug conjugate approved for advanced urothelial carcinoma (aUC), has limited real-world safety data and no validated predictive biomarkers. Retrospective studies suggest higher objective response rates (ORR) among patients developing EV-related dermatologic toxicities, but survival implications remain unclear. This analysis assessed the safety of EV monotherapy and the impact of dermatologic and neurologic toxicities on efficacy outcomes in a multi-institutional cohort. UNITE is a multicenter, retrospective study across 16 US sites of patients with aUC treated with targeted agents, including EV. Primary endpoints were the incidence of EV treatment-related adverse events (TRAEs, any grade) and TRAE-related treatment modifications. Secondary endpoints included a comparison of ORR, progression-free survival (PFS), and overall survival (OS) between patients with and without dermatologic toxicities and neuropathy. To reduce immortal time bias, Cox regression models incorporated TRAEs as time-dependent covariates to adjust for EV treatment duration as well as Eastern Cooperative Oncology Group performance status (ECOG PS), hemoglobin, and liver metastases. Between 2018 and 2023, 485 patients with aUC received > 1 dose of EV monotherapy. Most (67%) received > 2 prior therapy lines. Any grade TRAEs occurred in 77%, most frequently neuropathy (36%) and dermatologic toxicities (27%); 57% required treatment modification and 21% discontinued EV, primarily due to neuropathy (9%) and fatigue (3%). Patients with dermatologic toxicities and neuropathy had higher ORR (56% vs. 42%; p = 0.007 and 64% vs. 35%; p < 0.0001, respectively). Neuropathy was independently associated with improved OS (HR 0.66; 95% CI 0.50-0.87; p = 0.002); dermatologic TRAEs were not associated with PFS or OS benefit. EV safety outside clinical trials was consistent with prior reports, with no new signals. Treatment modifications were most often due to neuropathy, dermatologic toxicities, and fatigue. Both dermatologic toxicities and neuropathy correlated with higher ORR, but only neuropathy was independently associated with improved OS.

348 Background: Skin toxicities from cancer therapies are common and often under-addressed in quality care discussions. This study explores the prevalence, management practices, and quality-of-life (QoL) impacts of dermatologic side effects among cancer patients in the Middle east, with a focus on patient-reported outcomes and care gaps. Methods: A cross-sectional survey was conducted among 143 adult cancer patients, predominantly female (95.1%) and diagnosed with breast cancer (94.4%). Participants completed sociodemographic, clinical, and dermatologic questionnaires, including the Skindex-16—a validated tool assessing QoL across symptom, emotional, and functional domains. Multivariate linear regression identified factors associated with worse QoL. Results: A majority (86%) experienced dermatologic side effects, with alopecia (85.3%), itching (60.8%), and rash (32.9%) being most common. Notably, 78.3% indicated they would consider altering cancer treatment if skin toxicities arose, and 12.6% had their treatment modified due to skin effects. Use of dermo-cosmetic products was high (83.2%), primarily for body care. However, only 29.4% consulted a dermatologist, and 63.6% relied on their oncologist for dermatologic guidance; 41.3% reported turning to social media. Among non-users of dermo-cosmetic products, 43.4% cited lack of healthcare professional guidance as a barrier. Cancer treatment was associated with positive behavioral changes, including increased sunscreen use (75.5%), facial and body moisturizer application, and reduced smoking ( p &lt; 0.005 ). Skindex-16 scores revealed moderate to severe QoL impact in 46.9% of participants, with the symptom domain most affected (mean score: 42.0). Factors associated with worse Skindex-16 total scores are listed in Table 1 (p &lt; 0.05 for all). Conclusions: Dermatologic toxicities are common and affect patient behavior and treatment decisions. Despite widespread use of skin-care products, gaps in professional guidance remain. Integrating onco-dermatologic support into multidisciplinary care can improve quality of life and treatment adherence. Factors associated with worse quality of life scores based on total Skindex-16 (combined symptom, emotional, and functional domains). Total Skindex-16 score Unstandardized B p-value Confidence interval Lower Bound Upper Bound Photosensitivity (yes vs no*) 14.674 &lt;0.001 7.146 22.201 Changes in skin pigmentation (yes vs no*) 10.229 0.007 2.837 17.621 Use of dermo-cosmetics (yes vs no*) 9.910 0.013 2.152 17.668 Stage of cancer (metastasis vs local*) 12.661 0.020 2.053 23.268 History of dermatologic condition (yes vs no*) 8.858 0.011 2.061 15.655 *Reference group.

In cancer drug therapy involving anti-epidermal growth factor receptor (EGFR) antibody drugs, skin disorders such as acneiform rash are frequently observed and often progress to severe forms, resulting in treatment discontinuation. The severity of these skin disorders has been reported to correlate with therapeutic efficacy. Therefore, appropriate management is essential to avoid interruption of treatment due to severe dermatological toxicity. Identifying patients at risk of developing serious skin disorders at the start of anti-EGFR antibody drug therapy is necessary to enable prophylactic or early intervention. However, risk factors for skin disorders induced by anti-EGFR antibody drugs remain poorly understood, and predicting the severity of these conditions is challenging. This review highlights findings from retrospective and prospective observational studies conducted to predict the severity of skin disorders associated with anti-EGFR antibody drugs.

Assessing the impact of special hygiene measures recommended for oncological patients undergoing chemotherapeutic therapy is an important area of preventive medicine, as complications of drug therapy such as dermatological reactions (skin toxicity) develop. This article is devoted to the study of the impact of hygiene measures aimed at preventing skin damage as complications of the use of chemotherapeutic drugs used to treat cancer patients. A study was conducted among 60 patients who were treated in the department of antitumor drug therapy No. 1 of the Clinical Oncological Dispensary No. 1. of Krasnodar in the period from November 2024 to February 2025, who had manifestations of dermatological toxicity during chemotherapy (acne – like rash, maculopapular rash, xerosis, skin cracks, paronychia). The degree of skin toxicity was assessed according to the National Cancer Institute Common Toxicity Criteria for Adverse Events v5.0. In the group of patients who did not use preventive hygiene measures, skin lesions appeared more often and were more pronounced: grade 1 was observed in 18 patients (41.9%), grade 2 was detected in 20 patients (46.5%), and the most pronounced grade 3 was in 5 people (11.6%). The overwhelming majority of patients in the second group who followed the prophylaxis (n=12 – 70.6%) had grade 1 skin toxicity, 4 patients (23.5%) had grade 2, and only 1 (5.9%) had grade 3. The present study confirms the need for further study of the effects of therapeutic, preventive and hygienic skin care measures in cancer patients in order to develop optimal recommendations for their use.

Urological cancers-including prostate, bladder, renal, and testicular cancers-are commonly treated with surgery, chemotherapy, radiation therapy, and immunotherapy. While these therapies improve survival outcomes, they often induce significant dermatological side effects that impair patients' quality of life and treatment adherence. This review synthesizes current literature on the prevalence, mechanisms, and psychosocial consequences of dermatological toxicities associated with urological cancer treatments. Common adverse effects include dermatitis, alopecia, photosensitivity, hyperpigmentation, and scarring, with severity varying by treatment modality. Chemotherapy frequently causes alopecia and hand-foot syndrome, while radiation therapy leads to dermatitis and long-term fibrosis. Immunotherapy, though revolutionary, is associated with pruritus, vitiligo, and severe cutaneous reactions such as Stevens-Johnson syndrome. The psychosocial burden of these dermatological effects-particularly impacts on body image and self-esteem-is substantial yet understudied. Multidisciplinary management strategies, including early dermatological intervention, patient education, and psychosocial support, are essential to mitigate these effects. Future research should focus on standardized protocols, personalized treatment approaches, and improved patient-reported outcome measures to optimize holistic cancer care.

IntroductionTyrosine kinase inhibitors (TKIs) are the standard treatment options for advanced clear cell renal cell carcinoma (ccRCC), but their toxicities can hinder optimal dosing, affecting clinical outcomes.Material and methodsA retrospective analysis of 96 patients treated with first-line line sunitinib at the National Research Institute of Oncology, Branch Kraków, Poland was conducted to assess the incidence and prevalence of organ toxicities in ccRCC and their impact on overall survival (OS).ResultsThe study included 96 patients. The median number of treatment cycles was 11 (IQR: 19), and the median duration was 63 weeks (IQR: 95). The most common toxicities were gastrointestinal (76.0%), fatigue (61.5%), and cardiovascular (49.0%), with 81.3% of patients experiencing multi-organ toxicity. Dose delays occurred in 37 patients (38.5%), mainly due to gastrointestinal (38.5%) and cardiovascular toxicity (21.9%). Dose reductions were required in 64 patients (66.7%), primarily for gastrointestinal (39.6%) and cardiovascular (16.7%) complications. Cardiotoxicity (p=0.017) correlated with improved OS. No OS differences were observed in enterotoxicity, hematologic, endocrine, dermatologic, or renal toxicity. Patients requiring dose reduction due to cardiotoxicity (p=0.012), hematologic toxicity (p=0.004) or gastrointestinal toxicity (p=0.004) had better survival than those without modifications. Patients requiring dose reduction due to any cause had better OS than those maintaining the initial dose. The timing or frequency of dose reductions had no significant impact.ConclusionsCardiotoxicity, gastrointestinal and hematologic toxicities requiring dose reduction were associated with improved survival, suggesting these toxicities may reflect treatment efficacy. The findings emphasize the need to balance toxicity and treatment continuity.

Diffuse Large B-Cell Lymphoma (DLBCL) is the most common subtype of Non-Hodgkin Lymphoma (NHL). The standard first-line treatment for DLBCL is the R-CHOP protocol. For relapsed or refractory cases, salvage regimens such as R-ICE, R-DHAP, or MATRIX are utilized. Cytarabine, a commonly used antimetabolite in hematologic malignancies, has various side effects, including dermatological toxicity. A 61-year-old male with DLBCL received six cycles of R-CHOP chemotherapy and was considered in remission. However, he presented with neurological symptoms, and imaging confirmed CNS relapse. The patient was started on the MATRIX regimen, including high-dose cytarabine. On the third day of treatment, he developed a palmar rash, which later progressed to petechiae and purpura on the trunk, back, and lower extremities. No systemic corticosteroid treatment was administered, and the rash gradually resolved by the 13th day. Cytarabine-induced skin reactions, such as palmar-plantar erythrodysesthesia, morbilliform rashes, and acute generalized exanthematous pustulosis, have been reported. However, cases involving petechiae and purpura are rare. These reactions are usually self-limiting and do not require systemic intervention. The severity of cytarabine-induced dermatologic toxicity may be dose-dependent, with repeated doses showing reduced severity. In this case, the patient exhibited a cutaneous reaction without systemic involvement, supporting the benign nature of cytarabine-related skin toxicity. This case highlights a rare dermatological reaction to cytarabine during the MATRIX regimen in a DLBCL patient with CNS relapse. Although cytarabine-induced skin toxicity is uncommon, clinicians should be aware of its potential manifestations and manage patients symptomatically to avoid unnecessary interventions while ensuring treatment continuation.

Introduction: The combination of 3D radiation therapy (3D-RT) with cisplatin has been the conventional treatment for squamous cell carcinoma of the head and neck for decades.Aims: To assess the impact of 3D radiotherapy with cisplatin on the Eastern Cooperative Oncology Group (ECOG) performance status and quality of life in terms of acute side effects among head and neck cancer patients.Methodology: After obtaining the hospital’s ethical approval, 106 head and neck cancer patients were enrolled at the Institute of Nuclear Medicine and Oncology, Lahore, Pakistan. Patients of both genders who were receiving radiotherapy or chemo-radiotherapy with stage I-III head and neck cancer with ECOG statuses 1 and 2 were enrolled. All patients received 70 grays in 35 fractions, with 2 grays per fraction, after a standard treatment of 40 mg/m2 cisplatin once weekly for seven weeks. All patients were followed up for assessment after one month post treatment. Patients who were included were evaluated once a month after radiation therapy and at weekly intervals during treatment. SPSS version 23 software (IBM Corp., Armonk, NY) was used to analyze the data. Chi-square and Fisher's exact test were applied, while a p-value ≤ 0.05 was taken as statistically significant.Results: All patients experienced acute side effects after radiation therapy with cisplatin up to seven weeks into their treatment, including dermatitis, mucositis, xerostomia, and dysphagia of varying grades. After a month of treatment, however, these grade-related modifications subsided for all patients. A total of 39 patients (36.2%) had acceptable ECOG status, while 67 patients (63.8%) had poor ECOG status. An insignificant difference was observed in the frequency of acute adverse effect grades between poor and good ECOG status patients at the 1st, 4th, and 7th week of treatment. At the 11th week of treatment, the frequency of mucositis, dysphagia, and dermatitis grades between poor and good ECOG status patients showed a significant difference. The majority of the patients (n = 57, 53.8%) had a poor quality of life, while 27 (25.5%) had a good quality of life as they improved clinically.Conclusion: Concurrent 3D-conformal radiotherapy with cisplatin in head and neck cancer patients is associated with significant acute dermatological and mucosal toxicities, leading to temporary deterioration in the ECOG performance status and quality of life. However, most patients showed recovery in functional status post treatment.

Cutaneous and oral mucosal adverse events (AEs) are among the most common non-hematologic toxicities observed during breast cancer treatment. These complications arise across various therapeutic modalities including chemotherapy, targeted therapy, hormonal therapy, radiotherapy, and immunotherapy. Although often underrecognized compared with systemic side effects, dermatologic and mucosal toxicities can severely impact the patients' quality of life, leading to psychosocial distress, pain, and reduced treatment adherence. In severe cases, these toxicities may necessitate dose reductions, treatment delays, or discontinuation, thereby compromising oncologic outcomes. The growing use of precision medicine and novel targeted agents has broadened the spectrum of AEs, with some therapies linked to distinct dermatologic syndromes and mucosal complications such as mucositis, xerostomia, and lichenoid reactions. Early detection, accurate classification, and timely multidisciplinary management are essential for mitigating these effects. This review provides a comprehensive synthesis of current knowledge on cutaneous and oral mucosal toxicities associated with modern breast cancer therapies. Particular attention is given to clinical presentation, underlying pathophysiology, incidence, and evidence-based prevention and management strategies. We also explore emerging approaches, including nanoparticle-based delivery systems and personalized interventions, which may reduce toxicity without compromising therapeutic efficacy. By emphasizing the integration of dermatologic and mucosal care, this review aims to support clinicians in preserving treatment adherence and enhancing the overall therapeutic experience in breast cancer patients. The novelty of this review lies in its dual focus on cutaneous and oral complications across all major therapeutic classes, including recent biologic and immunotherapeutic agents, and its emphasis on multidisciplinary, patient-centered strategies.

Chloroquine has been linked to numerous adverse effects impacting several organ systems in the body. The dermatologic adverse effects of chloroquine have not been extensively analyzed in the current literature. A recent publication reviewed these effects of hydroxychloroquine, a medication with a similar composition and use as chloroquine. We conducted a narrative review of the English literature on this topic to better understand the dermatologic toxicity of chloroquine. Many of the dermatologic adverse effects associated with chloroquine use identified in this review were well tolerated or resolved after discontinuation of treatment. The most commonly reported adverse dermatologic effect of chloroquine was pruritus, with at least 464 distinct cases across 29 studies. All dermatologic reactions to chloroquine occurred within 3 months of drug initiation. Due to the varying reporting styles and methodology of studies, this analysis demonstrates the need for future studies to better elucidate the risks for dermatologic adverse effects of chloroquine regarding underlying conditions and treatment regimens. Future research should aim to identify all possible dermatologic adverse effects so that clinicians may confidently determine the risk to their patients.

High-dose chemotherapy (HDCT) followed by autologous hematopoietic stem cell transplantation (auto-HSCT) is a therapeutic option that allows potentiating the antitumor effect in patients with malignant neoplasms (MNs) belonging to the high-risk group. However, despite the effectiveness of this method, the risks of developing infectious and toxic complications in the early and late post-transplantation period are higher than the risks associated with treatment according to standard protocols and can significantly worsen the results of transplantation. We carried out a retrospective analysis of the results of auto-HSCT in a cohort of 156 patients with high-risk solid MNs treated at the L.A. Durnov Research Institute of Pediatric Oncology and Hematology, the N.N. Blokhin National Medical Research Center of Oncology of Ministry of Healthcare of the Russian Federation in 2020–2023. The study was approved by the Independent Ethics Committee and the Scientific Council of the N.N. Blokhin National Medical Research Center of Oncology. The study included 78 (50%) boys and 78 (50%) girls, the median age of the patients was 8 years 7 months (9 months – 17 years 8 months). Auto-HSCT was performed in 90 (57.7%) patients with neuroblastoma, 25 (16.0%) – with Ewing's sarcoma, 16 (10.3%) – with germ cell tumors, 13 (8.4%) – with nephroblastoma, 7 (4.5%) – with retinoblastoma, 3 (1.9%) – with medulloblastoma, 1 (0.6%) patient with pleuropulmonary blastoma and 1 (0.6%) patient with sialoblastoma. We used the following conditioning regimens: treosulfan + melphalan (n = 116), carboplatin + thiotepa + etoposide (n = 17), melphalan (n = 13), carboplatin + thiotepa + etoposide + cyclophosphamide (n = 10). Depending on the clinical indications and the treatment protocol used, 136 (87.2%) patients underwent one course of HDCT, and 20 (12.8%) patients underwent tandem HDCT. In most patients, the median recovery time for granulocytes and platelets was 11 (8–19) days and 14 (12–21) days, respectively. The most common infectious complications in patients after auto-HSCT were mucositis (89.1%), neutropenic enterocolitis (76.9%), febrile neutropenia (71.2%), less often: catheter-associated bloodstream infection (9%), pneumonia (14.1%), acute respiratory distress syndrome (0.6%). As regards toxic complications, all patients had emetic syndrome, 98 (62.8%) had dermatological toxicity, 9 (5.8%) had hemorrhagic cystitis, 116 (74.3%) had hepatic toxicity, 14 (9%) had neurotoxicity, 102 (65.4%) had moderate nutritional insufficiency. Episodes of hemorrhagic syndrome due to thrombocytopenia were observed in 44.2% of patients. After auto-HSCT, most patients develop chemotherapy-induced (including infectious) complications, which can not only significantly disrupt the patients’ well-being and quality of life, but also, depending on the severity, pose a threat to their life. The correct choice of conditioning regimen, effective collection of hematopoietic stem cells, complex accompanying therapy, timely diagnosis and treatment of complications can significantly improve the results of auto-HSCT in children with high-risk solid MNs.

PURPOSE The frequent occurrence of immune-related adverse events during immune checkpoint inhibitor therapy for non–small cell lung cancer (NSCLC), particularly dermatologic toxicities, often necessitates treatment modifications and systemic corticosteroid use, negatively affecting patient outcomes. This study evaluated the impact of a multidisciplinary prophylactic intervention on the incidence of severe skin toxicities among patients receiving nivolumab + ipilimumab (NI) with or without chemotherapy. PATIENTS AND METHODS This single-center, retrospective, observational study included 154 treatment-naïve patients with NSCLC who received NI with or without chemotherapy. A comparison was made between skin toxicities and clinical outcomes before and after the implementation of a prophylactic intervention consisting of physician-prescribed medications, pharmacist-led patient education, and nurse-guided skincare. The primary end points were the incidence of grade 3 or higher skin toxicities, systemic corticosteroid use, and treatment discontinuation. Secondary end points included progression-free survival (PFS) and overall survival (OS). RESULTS The incidence of grade 3 skin toxicities significantly decreased from 21% before the intervention to 8% after the intervention ( P = .045). Systemic corticosteroid use and treatment discontinuation rates due to skin toxicities reduced from 36% to 10% ( P = .0004) and from 21% to 4% ( P = .0012), respectively. Patients with any grade of skin rash exhibited significantly improved PFS and OS compared with those without skin toxicities. However, grade 3 toxicities were associated with poor OS. CONCLUSION Prophylactic interventions significantly reduced the severity of skin toxicities and enhanced treatment continuity in patients with NSCLC receiving nivolumab and ipilimumab–based therapy. These findings underscore the importance of proactive, multidisciplinary management strategies to optimize therapeutic outcomes.

Abstract Programmed cell death protein-1 (PD-1) and its ligand PD-L1 are key immune checkpoints that play a crucial role in regulating immune responses. In oncology, immune checkpoint inhibitors (ICIs) targeting PD-1/PD-L1 enhance antitumour immunity by preventing tumour cells from evading immune detection. Cemiplimab, a PD-1 inhibitor, has demonstrated efficacy in treating metastatic squamous cell carcinoma (SCC), significantly improving patient outcomes. However, ICIs are increasingly recognized for their potential to induce novel immune-related adverse events (irAEs), particularly dermatological toxicities. Reported cutaneous irAEs include lichenoid eruptions, alopecia areata and vitiligo, among others. Here, we present a case of erythrodermic psoriasis following a second cycle of cemiplimab. A patient undergoing cemiplimab treatment for metastatic SCC developed a widespread scaly rash following their second cycle of therapy. Clinical examination revealed islands of sparing within an erythematous and scaly eruption. This was managed initially with topical treatment and oral prednisolone. Over the subsequent 8 weeks, the rash progressed to a severe erythrodermic presentation, characterized by diffuse erythema, desquamation and marked hyperkeratosis, including prominent palmoplantar hyperkeratosis. The patient was admitted and commenced on intravenous methylprednisolone, leading to symptom resolution within 7 days. Upon discharge, he was transitioned to a tapering regimen of oral prednisolone, starting at 100 mg with weekly dose reductions. At follow-up, there was no evidence of disease flare. Histopathological analysis from two punch biopsies revealed a psoriasiform reaction pattern, supporting a diagnosis of psoriasis rather than pityriasis rubra pilaris. Cutaneous toxicities from immune checkpoint inhibitors are increasingly recognized, often mimicking primary dermatological disorders. Reports of ICI-induced alopecia, vitiligo and lichenoid dermatoses highlight the spectrum of immune-mediated skin reactions. Our case underscores the potential for cemiplimab to trigger psoriasis, which may theoretically be associated with aberrant expression of IL-17 and IL-23, further illustrating the diversity of cutaneous irAEs. Understanding the pathophysiological mechanisms underlying these toxicities is essential for optimizing treatment strategies, minimizing adverse effects without compromising ICI efficacy, and ultimately prolonging patient access to immunotherapy. Further research into immune-related dermatological conditions may also provide valuable insights into the molecular mechanisms governing endogenous dermatological diseases, offering new avenues for targeted dermatological therapies.

The rise of fad diets and unregulated supplement use, amplified by social media and aggressive marketing, has dramatically shifted public attitudes toward nutrition and health. This new landscape is associated with a growing spectrum of dermatologic presentations, as the skin frequently serves as an early indicator of both nutritional deficiencies and toxicities. Popular dietary trends, such as ketogenic, carnivore, and raw vegan regimens, have been linked to cutaneous disorders, including prurigo pigmentosa, scurvy-like eruptions, hair loss, xerosis, and pigmentary changes. In parallel, the overuse of supplements like niacin, selenium, and zinc is increasingly implicated in cases of dermatologic toxicity, presenting as flushing, dermatitis, alopecia, and nail dystrophy. Fitness-oriented supplements, particularly whey protein, are now recognized contributors to acne flares, likely via insulin and IGF-1 pathways.Given the high prevalence of health misinformation online and the lack of regulation surrounding dietary supplements, dermatologists and allied clinicians must prioritize thorough dietary and supplement histories, recognize the skin's role as an early warning system for nutritional imbalance, and provide evidence-based patient counseling. A multidisciplinary approach that integrates clinical vigilance, interdisciplinary education, and public health advocacy will be crucial for reducing the burden of nutrition-related skin disease and promoting safe, effective dietary practices. The clinical recognition of these diet- and supplement-induced dermatoses is complicated by their overlap with more common inflammatory or autoimmune skin diseases, often leading to misdiagnosis and delayed management of the underlying nutritional etiology.

Immunotherapy has revolutionized cancer treatment, offering significant survival superiority for advanced malignancies. However, immunotherapy is associated with various immune-related adverse events, one of the most common of them being dermatologic toxicities. Previous studies have reported dermatologic adverse events in almost half of the cancer patients undergoing immunotherapy. The spectrum of dermatologic toxicities ranges from mild, self-limiting reactions to severe, life-threatening conditions, and includes maculopapular rash, pruritus, vitiligo-like depigmentation, psoriasiform eruption, lichenoid eruption, bullae, photosensitivity, hair loss, nail changes, Stevens-Johnson syndrome, and toxic epidermal necrolysis. The management strategies are based on personalized treatment plans, multidisciplinary approaches, and timely therapeutic interventions aimed at addressing dermatologic toxicities while preserving immunotherapy efficacy. Based on the latest findings, this paper offers a novel perspective and provides an evidence-based review of the pathogenesis, manifestations, incidence, grading, clinical management, and prognostic significance of these toxicities, underlining the importance of balancing the efficacy of immunotherapy with timely and proactive management of their dermatological toxicities to enhance patient outcomes and quality of life.

Enfortumab vedotin-related skin toxicities in patients with urothelial carcinoma: A systematic review and meta-analysis.

e15015 Background: Antibody-drug conjugates (ADCs) have demonstrated significant efficacy in treating patients with breast cancer. However, the toxicity variations between these agents are not yet thoroughly elucidated. This study aims to systematically compare the toxicity profiles of various ADCs used in breast cancer therapy to better inform clinical decision-making. Methods: We conducted a systematic review of randomized controlled trials (RCTs) published by September 2024. Treatment-related adverse events (TRAEs) of the investigational ADCs and standard of care control were classified into systemic categories based on Common Terminology Criteria for Adverse Events. Bayesian models were employed to facilitate the indirect comparisons of TRAEs associated with different ADCs and reported using surface under the cumulative ranking curve (SUCRA) values. The study protocol was prospectively registered on PROSPERO (CRD42024606194). Results: A total of 9307 patients in 17 RCTs of five different ADCs (ado-trastuzumab emtansine [T-DM1], sacituzumab govitecan [SG], trastuzumab deruxtecan [T-DXd], datopotamab deruxtecan [Dato-DXd], and ARX788) were included. SG and T-DXd monotherapy were associated with the highest risk of neutropenia/anemia, with SUCRA values of 11.2%/26.7%, and 20.7%/17.1%, respectively. T-DM1-containing regimens had the highest incidence of thrombocytopenia, which was exacerbated when combined with chemotherapy compared to monotherapy. In terms of gastrointestinal (GI) toxicities, SG was associated with the highest risk of diarrhea, followed by comparable risks between T-DM1 combined with chemotherapy and anti-HER2 and chemotherapy combined with dual anti-HER2 therapy. T-DXd was associated with a relatively higher incidence of vomiting (9.5%), while the highest risk of nausea was seen with chemotherapy with dual anti-HER2 therapy and T-DXd. SG and T-DXd were more likely to cause fatigue, decreased appetite, and dermatological disorders, including alopecia, rash, and pruritus, while T-DM1 combined with anti-HER2 therapies was linked a higher risk of pyrexia. T-DM1-containing regimens were also related to liver function test abnormalities, musculoskeletal and neurological disorders. Dato-DXd was associated with a higher risk of fatigue and dermatological toxicities, while ARX788 was associated with the least hematological and GI TRAEs. Conclusions: This Bayesian network meta-analysis highlights significant variability in TRAEs among different ADCs in breast cancer therapy. T-DM1 was primarily associated with thrombocytopenia and hepatic toxicities, while SG and T-DXd were associated with neutropenia, anemia, GI disorders, and dermatological TRAEs. Our findings may help with selection of ADC therapies for patients with breast cancer, facilitating personalized approaches to minimize treatment-related toxicities.

e21542 Background: Immunotherapy and target therapy have revolutionized melanoma treatment. However, adverse events (AEs) are still frequent and might impact treatment adherence. Female sex was demonstrated to be associated with a higher risk of AEs from cytotoxic therapy related to cancer treatment. This study aims to conduct a systematic review and meta-analysis to investigate Sex and Gender (S/G) effect on adverse events. Methods: We extracted data from independent studies published until April 2024 with information regarding toxicity by S/G. Only studies that involved patients with melanoma as primary disease were included. Summary Odds ratios OR (sOR) estimates were obtained through random-effects models, and 95% Confidence Intervals (CI) were estimated. I 2 was used to evaluate the between-study heterogeneity. Publication bias was investigated with Begg and Egger tests. Results: Information regarding toxicity and gender were extracted from seventy articles. A significant increase in AE related to the thyroid was observed in women (sOR = 2.01, 95%CI [1.41-2.85], I² = 29). S/G did not affect Grade III-IV, Dermatological, Gastrointestinal, Hypophyses, Kidney, Liver or Ocular toxicities. The increased risk of AE related to the thyroid was mainly seen in those undergoing first-line treatments, sOR = , 2.16 [1.36-3.42], and those who underwent mono and combo therapy. Women undergoing TT (target therapy) had an increased risk of dermatological (sOR = 1.94, 95%CI 1.51-2.50, I² = 0%) AE. Conclusions: This study supports and extends the discussion on the impact of S/G on the development of toxicities. Women have an increased risk of AE related to the thyroid, mainly seen during first-line treatment, and showed an increased risk of dermatological AE when treated with TT. Women should be monitored closely for precursor signs of thyroid-related AE, as well as dermatological and generally severe AE, to preserve good treatment adherence.

Dermatologic toxicities resulting from cancer treatments are common, debilitating, and can significantly impact a patient's quality of life. In some cases, these toxicities may require dose adjustments or even discontinuation of treatment. Timely management of dermatologic adverse events (DAEs) is crucial to improving patient outcomes, and educational resources are instrumental in empowering patients to recognize and manage these issues. This cross-sectional survey study aims to characterize patient utilization of and satisfaction with educational resources regarding dermatologic toxicities of cancer treatments. Findings indicate that while 77.5% (n = 110) of patients received information on managing dermatologic toxicities, a larger proportion (n = 123; 86.5%) experienced these side effects. Healthcare providers were the primary source of information (n = 102/110; 92.7%), followed by self-searching on the internet (n = 59/110; 53.6%), and social media (n = 43/110; 39.1%). Despite most patients receiving educational content, patients expressed low satisfaction with both the quality and quantity of information provided, with only 31.3% (n = 41) reporting satisfaction with the amount of information and 33.8% (n = 44) reporting satisfaction with its quality, highlighting a significant gap in resource effectiveness. Notably, patients reported the highest satisfaction with information provided by healthcare providers, suggesting that integrating comprehensive dermatologic education into oncologic care could improve patient satisfaction and outcomes.