EGFR inhibitors bind to receptors on normal epidermal cells found in human skin and the gastrointestinal lining.10, 32, 33 Although the exact biology is not fully understood it is thought that different mechanisms occur to interfere with keratinocyte growth and survival, cell differentiation and attachment, and migration from basal to stratum corneum.32, 33 The results are inflammation and dryness of the skin, leading to hyperkeratosis, folliculitis, and finally a papulopustular rash that usually occurs within the first three weeks of treatment.32, 33
The spectrum of skin toxicities can vary in severity. Most commonly reported reactions include a mild to moderate skin rash that occurs on the face, upper chest, back, and dorsal arms (sun exposed areas).32, 33 There can be an increased incidence of the inflammatory reactions and sensitivity to sun exposure. Other changes can include xerosis / pruritus, periungual or nail alterations, hair loss, and eye or eyelash abnormalities. 21 The effects appear to be specific to the EGFR targeted therapies.
How the SCN responds providing education and support measures to the individual experiencing this toxicity will impact the individual's compliance with these targeted therapies. The SCN needs to be proactive in the management of skin toxicities and provide information and support.32, 33
Search the literature to identify interventions to prevent, minimise, and/or manage skin toxicities associated with monoclonal antibody administration.
Outline the evidence based information and supportive care strategies to prevent and manage dermatological effects associated with EGFR inhibitors in the following circumstances:
- mild skin toxicity
- moderate skin toxicity
- severe skin toxicity.