Management of Exanthematous Rashes

Diagnosis and Assessment

• The American Society of Clinical Oncology recommends avoiding frequent washing with hot water and skin irritants such as OTC anti-acne medications for patients with anticancer agent-induced rashes 1, 2

Management Approach Based on Etiology

Drug-Induced Exanthematous Rashes

• The European Society for Medical Oncology suggests applying alcohol-free moisturizers containing 5-10% urea twice daily for patients with anticancer agent-induced rashes 1, 3
• The National Comprehensive Cancer Network recommends using topical corticosteroids and oral tetracycline antibiotics (doxycycline 100mg twice daily or minocycline 100mg daily) for at least 6 weeks for grade 1-2 rashes 3
• The American Society of Clinical Oncology advises considering short-course systemic corticosteroids (prednisone 0.5-1 mg/kg for 7 days with 4-6 week taper) and interrupting the causative medication until rash improves to grade 1 for grade 3 rashes 3
• The Society for Immunotherapy of Cancer recommends continuing immunotherapy while treating with topical emollients and mild-moderate potency corticosteroids for grade 1 immune checkpoint inhibitor-related rashes 4
• The European Society for Medical Oncology suggests considering holding immunotherapy, using medium-high potency topical corticosteroids, oral antihistamines, and possibly prednisone 0.5-1 mg/kg for grade 2 immune checkpoint inhibitor-related rashes 4
• The American Society of Clinical Oncology advises holding immunotherapy, initiating systemic corticosteroids (prednisone 1 mg/kg/day or IV methylprednisolone 1-2 mg/kg), and consulting dermatology for grade 3-4 immune checkpoint inhibitor-related rashes 4

Infectious Exanthematous Rashes

• The Infectious Diseases Society of America recommends obtaining bacterial culture and administering appropriate antibiotics for at least 14 days based on sensitivity results for suspected bacterial superinfection 3
• The British Medical Journal suggests considering flucloxacillin for Staphylococcus aureus infections 5
• The American Academy of Pediatrics recommends using phenoxymethylpenicillin for β-hemolytic streptococci infections 5
• The Infectious Diseases Society of America advises using erythromycin as an alternative for patients with penicillin allergy 5
• The American Academy of Dermatology recommends administering oral acyclovir early in the disease course or intravenous acyclovir for ill, febrile patients with herpes virus infections presenting with mucosal involvement 5

General Skin Care Recommendations

• The American Academy of Dermatology suggests using gentle, non-irritating cleansers and avoiding frequent washing with hot water 1, 2
• The National Eczema Association recommends applying alcohol-free moisturizers regularly to maintain skin barrier function 1, 3
• The Skin Cancer Foundation advises using sun protection (SPF 15 or higher) on exposed areas of the body 1, 3
• The American Academy of Dermatology recommends avoiding skin irritants including harsh soaps, solvents, and disinfectants 1, 2

When to Refer to Dermatology

• The American Academy of Dermatology suggests referring patients with rashes that do not respond to first-line treatment measures 5
• The Society for Immunotherapy of Cancer recommends referring patients with suspected autoimmune skin disease 4
• The American Society of Clinical Oncology advises referring patients with severe rashes (grade 3-4) or those with systemic symptoms 4
• The European Society for Medical Oncology suggests referring cases requiring skin biopsy for definitive diagnosis 4