Management of Dermatological Toxicities in Cancer Patients

Introduction to Steroid Use

The European Society for Medical Oncology recommends topical corticosteroids for managing chemotherapy-induced skin toxicities, with high-potency topical steroids being the standard treatment for palmar-plantar erythrodysesthesia syndrome (PPES) and hand-foot skin reactions in patients receiving chemotherapy agents like capecitabine, doxorubicin, and taxanes 1, 4, 6
For Grade 1-2 skin reactions from anticancer agents, the European Society for Medical Oncology suggests topical high-potency steroids should be applied twice daily while continuing cancer treatment 2, 3, 7
The European Society for Medical Oncology recommends oral dexamethasone (8 mg twice daily for 5 days beginning the day before infusion) in addition to topical steroids for Grade 2 PPES from doxorubicin/taxanes 2, 3, 8, 6
For papulopustular rashes from EGFR inhibitors, the European Society for Medical Oncology recommends topical low/moderate-potency steroids alongside oral antibiotics 9
For immune checkpoint inhibitor-related rashes, the Society for Immunotherapy of Cancer indicates systemic corticosteroids (prednisone 0.5-1 mg/kg/day) are indicated for Grade 3 reactions covering >30% body surface area 10

High-potency topical steroids, such as clobetasol propionate 0.05%, are recommended for the treatment of palmar-plantar erythrodysesthesia syndrome (PPES) and hand-foot skin reactions in patients receiving chemotherapy agents like capecitabine, doxorubicin, and taxanes 1, 4, 5, 6
Topical low/moderate-potency steroids are recommended for the treatment of papulopustular rashes from EGFR inhibitors, alongside oral antibiotics 9