Managing Skin Toxicities in Cancer Care: The Importance of Patient Awareness and Early Recognition

At the San Antonio Breast Cancer Symposium (SABCS) in San Antonio, Ian Tattersall, MD, PhD, highlights key challenges and practical strategies for recognizing and managing dermatologic toxicities associated with cancer therapies. Tattersall emphasizes that skin-related adverse events are highly dependent on the specific treatment regimen but notes that gaps in patient awareness frequently delay recognition and reporting of symptoms. Patients may initially dismiss changes such as nail or skin abnormalities, not realizing they fall within the expected spectrum of treatment-related toxicities, underscoring the need for proactive education without causing unnecessary alarm.

Pharmacy Times: Skin toxicities are among the most common and visible treatment-related adverse effects in oncology. From your perspective, what are the biggest gaps in early recognition that still lead to preventable dose reductions or treatment interruptions?

Ian Tattersall, MD, PhD: I think a lot of this is very dependent on the exact nature of the treatment that you're undergoing, but I think a lack of awareness is really important, and a lack of patient awareness as well. I often have patients who will basically tell me that nothing's wrong with their skin. And then when you ask directed questions about, well, are you having problems with your fingernails, they'll say, “Oh, I didn't realize that that was part of what we were doing here,” or that was part of the range of toxicities that could be happening from your treatment. I just thought it was happening for another reason.

So I think patient understanding of what could go wrong, or what they should look out for, is important. Not to catastrophize, but to be aware should something come up. Another thing I think that is very challenging is the recognition of inflammation or of early rashes in different skin tones. Often, people with darker skin pigmentation may have rashes that appear less classic and less easily recognizable, because most of the available data, most of the available pictures, and the familiarity that we have with skin toxicity are in lighter-skinned patients.

Pharmacy Times: Oncology pharmacists are often the first to hear about rash, pruritus, or hand–foot syndrome during follow-up calls. What early management strategies do you believe pharmacists can implement that meaningfully reduce progression to severe toxicity?

Ian Tattersall, MD, PhD: I think contact with the oncologists and management in terms of addressing the dose is really important, and you don't want people to take things too much into their own hands. That said, there are a number of gentle skin care and supportive skin measures that are pretty easy to take and can hopefully be effective in at least ameliorating a little bit of the toxicity. Things like moisturizing your skin really well, making sure that you're using soaps and detergents that are mild and fragrance-free, and sun protection, which is one of the most important things.

So many of the toxicities that we see in the skin are aggravated and exacerbated by sun exposure. Using sun protection, using sunscreen, making sure that you cover up, and avoiding the peak hours of sunlight during the day are especially important if you're on a medication that is photo-exacerbated or has toxicity that comes out with sun damage.