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Skin Reactions to Targeted Therapy and Immunotherapy
Approved by the Cancer.Net Editorial Board, 07/2019
This content was last updated 1 November 2021.
Targeted therapy and immunotherapy are specific types of cancer medications. Like other cancer treatments, they often cause side effects. There are some similarities and differences in side effects between these types of cancer medications compared to chemotherapy drugs. This information explains changes to the skin, included related changes to hair, nails, and eyes, that can happen during treatment with targeted therapy or immunotherapy.
Let your health care team know about any symptoms you experience. This includes any new symptoms or a change in symptoms. Managing skin reactions and other cancer side effects is an important part of your medical care and treatment. This type of care is called palliative care or supportive care.
What is targeted therapy?
Targeted therapy is a treatment that targets the specific genes, proteins, or the tissue environment that contributes to cancer growth and development. Some targeted therapies can cause specific side effects to the skin, hair, and nails. These side effects are caused by the effect of medications on the healthy growth of these tissues.
Targeted therapies that may cause skin problems
The following are some of the types of targeted therapies that may affect the skin. If your doctor prescribes a targeted therapy, ask what side effects to expect and how they will be treated.
Drugs that target EGFR. This common type of targeted therapy focuses on a molecule known as epidermal growth factor receptor (EGFR). EGFR fuels the growth of cancer cells. It also plays a role in the normal growth of the skin, hair, and nails. This means rashes and changes to the hair and nails may occur during treatment with these drugs.
Most people taking drugs that target EGFR develop a rash on their face and upper body. It usually happens within the first few weeks of taking these medications. You may notice redness or a warm sensation like a sunburn before the rash begins. After several days, pimples and pus bumps appear, and the surrounding skin feels slightly tender. Rashes are usually mild to moderate. But some people have severe rashes that cause major physical and cosmetic discomfort.
The skin can also become very dry and itchy, interfering with daily activities and sleep. Skin on the fingertips may crack. Skin may also become more sensitive to sunlight. A lot of scratching can result in breaks in the skin. These openings make the skin more prone to infections. Inflammation around the nails can make grooming, dressing, and other activities painful or difficult.
Drugs that target VEGF. Another type of targeted therapy that may cause skin problems includes drugs that block a protein called vascular endothelial growth factor (VEGF). This protein helps make new blood vessels. This group of drugs may also be called angiogenesis inhibitors because they block the formation of blood vessels. When these drugs affect the blood vessels in the hands and feet, they can cause skin problems.
Your health care team can help you manage these side effects so treatment can continue. Managing these side effects can also help avoid major changes to your skin, hair, and nails. It is important to note that the skin side effects linked with these drugs are not allergic reactions or infections.
Common skin-related side effects of specific targeted drugs
Below is a list of common targeted therapy drugs that can cause skin related problems.
Afatinib (Gilotrif), cetuximab (Erbitux), erlotinib (Tarceva), gefitinib (Iressa), osimertinib (Tagrisso), and panitumumab (Vectibix). These drugs may be prescribed for colorectal cancer, head and neck cancer, lung cancer, and pancreatic cancer. Skin-related side effects include:
Acne-like rash on face and upper body
Inflammation around fingernails
Dry, itchy skin
Fingertip cracking
Hair loss on scalp
Increased, curly, or coarse hair on face and eyelashes
Increased sensitivity to sunlight
Lapatinib (Tykerb). This is used to treat breast cancer. Skin-related side effects include:
Sores on lips, mouth, or throat
Dry skin
Red, painful, numb, or tingling hands and feet
Rash
Sorafenib (Nexavar) and sunitinib (Sutent). This is used to treat renal cell cancer, gastrointestinal stromal tumor (GIST), and hepatocellular cancer. Side effects include:
Hand/foot skin reactions (tender, thickened areas sometimes with blisters on palms and soles)
(Video) Life After Treatment: A Conversation About the Side Effects of Immunotherapy vs Targeted TherapyRedness and flaking on scalp and eyebrows
Warm, burning sensation on the face along with redness
Dry, itchy skin
Hair loss
Vemurafenib (Zelboraf). This is used to treat melanoma. Skin-related side effects include:
Red rash on the face and upper body
Bumpy, rough rash on arms and thighs
Hand/foot skin reactions
Skin growths, including non-dangerous skin cancers
More sensitivity to sunlight
Everolimus (Afinitor, Zortress) and temsirolimus (Torisel). These targeted therapy drugs are used for renal cell cancer, non-small cell lung cancer (NSCLC), pancreatic neuroendocrine tumor (a type of pancreatic cancer), and subependymal giant cell astrocytoma (a benign brain tumor associated with tuberous sclerosis). Side effects include:
Mouth sores or canker sores
Bumpy rash on the upper body
Acne-like rash
Vandetanib (Caprelsa). This is used to treat medullary thyroid cancer. Side effects include:
Rash or acne
Dry, peeling, or itchy skin
Blisters or sores
Skin redness
What is immunotherapy?
Immunotherapy, also called biologic therapy, is a type of cancer treatment. It uses the body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells.
Common skin-related side effects of immunotherapy
Most skin reactions to immunotherapy are caused by a certain class of drugs called immune checkpoint inhibitors. These drugs target molecules such as PD-1, PD-L1, and CTLA-4. Examples of these medications include ipilimumab, nivolumab, and pembrolizumab, among others.
The skin-related reactions to immune checkpoint inhibitors are relatively uncommon but may include:
Rash
Skin that feels itchy, burning, or tight
Blistered skin, also called bullous dermatosis
Peeling or cracked skin
Reddening or other discolored patches of skin
Patches of purple spots called purpura
Painful skin
Patchy areas of hair loss
Skin reactions can occur anywhere on the body, even in the mucus membranes. Affected areas of skin may be small or cover large areas of the body. Treatment may include moisturizing skin creams, antihistamine medications, and/or steroids. Depending on the severity of the side effect, your doctor may pause or permanently stop treatment with the immune checkpoint inhibitor.
If you get care for your skin condition at a place not familiar with your cancer treatment, be sure to tell the health care team there that you are on immunotherapy. For instance, you may decide to go to an emergency room or see a dermatologist. If possible, give them the name of the drug, your oncologist, and cancer center where you receive immunotherapy. Keep this information in your wallet or phone in case you need it quickly. Download and print Cancer.Net's foldable wallet card to organize this information.
Learn more about the side effects of immunotherapy.
The information in this section is based on ASCO recommendations on managing side effects related to treatment with immune checkpoint inhibitors. Note that this link takes you to a different ASCO website.
Managing and relieving skin problems from targeted therapy and immunotherapy
Rashes, dry skin, and nail and hair reactions are rarely severe. But they can cause major discomfort. Patients may even want to stop cancer treatment because of these reactions. It is important to talk with your health care team about what to expect. Also tell your doctor as soon as you start feeling or seeing any side effects. There are early and effective treatments for these reactions.
The following suggestions may help avoid reactions and help relieve them if they do happen:
Before you begin treatment, talk with your health care team about the side effects. If you have existing skin problems before starting immunotherapy, you may wish to talk with a dermatologist. A dermatologist is a doctor who specializes in skin conditions. Ask what to do if a rash or other problems appear. This may include how to get a prescription filled or the best way to see the doctor.
At the first sign of a reaction, tell your doctor or a dermatologist familiar with these reactions. Signs of a reaction include a warm or burning sensation, itching, bumps or blisters, nail cracks, or dry skin.
Protecting your skin from the sun may help prevent skin problems while you are receiving immunotherapy. Use a sunscreen with a sun protection factor (SPF) of at least 15. If the sunscreen causes a burning sensation, you can try sunscreens that contain zinc oxide or titanium dioxide. Remember to use enough sunscreen. Apply more than half a teaspoon of sunscreen to each arm, your face, and your neck. Apply just over 1 teaspoon to your chest and abdomen, your back, and each leg. Re-apply sunscreen every 2 hours when outdoors, or more often if sweating or swimming. Use a broad-brimmed hat and sun-protective clothing and avoid being in direct sunlight between 10 AM and 4 PM.
Use a mild soap in the shower. Avoid soaps with strong scents. Shower with lukewarm water and avoid long, hot showers. Also, avoid laundry detergent with strong perfumes.
Apply a cream-based moisturizer to all skin within 5 minutes of showering or bathing. Use hypoallergenic moisturizers that do not have perfumes or preservatives, such as Vanicream, Aveeno, CeraVe, Cetaphil, and Eucerin.
Avoid anti-acne skin products that have alcohol or retinoids. They can dry out your skin.
(Video) Recent Advances in Treating Melanoma & Skin Cancer PreventionYour doctor may prescribe medicated skin creams for a rash. If the rash is severe or covers a large area of the body, you may need oral corticosteroids, such as prednisone or dexamethasone (available as generic drugs).
Whenever there is discharge of pus, your doctor may take a sample of it to help choose the best antibiotic treatment.
For hand/foot skin reactions to the targeted therapies sorafenib and sunitinib:
Use creams containing urea called carmol 20 or carmol 40, or salicylic acid (multiple brand names). Strong corticosteroids such as fluocinonide (multiple brand names) and clobetasol (multiple brand names) are also options.
Wear thick, comfortable socks and shoes, or try gel insoles. Also, do your best to protect against injury. Do not put too much weight on your hands and feet, especially during the first 2 months of treatment.
- For itching that does not involve a rash, an anti-itch cream can be applied to the area for relief. For more serious itching or itching that affects sleep, talk with your doctor about whether other medications may be an option.
Related Resources
Skin Conditions
Side Effects of Immunotherapy
What People With Cancer Should Know About Immune Checkpoint Inhibitor Side Effects
What It's Like Taking Immunotherapy to Treat Cancer
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Download ASCO's free Rash fact sheet. This 1-page printable PDF gives an introduction to rashes, including symptoms, how it is treated, ways to manage discomfort, words to know, and questions to ask the health care team. It also includes a tracking sheet to record when the rash started and where and how it appears.
Coping With Cancer
More in this section
- Managing Emotions
- Physical, Emotional, and Social Effects of Cancer
- What is Palliative and Supportive Care?
- Types of Palliative and Supportive Care
- Getting Started With Palliative Care
- Managing Physical Side Effects
- Spiritual Support When You Have Cancer
- Talking With Family and Friends
- Caring for a Loved One
- Finding Social Support and Information
- Cancer from the Oncologist's Perspective
FAQs
What are the skin side effects of targeted therapy? ›
Possible side effects
Skin problems are a common side effect of targeted therapy. Different drugs may cause: sensitivity to sunlight, skin redness, swelling and dry, flaky skin. a rash that looks like acne or pimples on the face, scalp or upper body (acneiform rash)
Some types of immunotherapy can cause a severe and sometimes extensive rash. Your skin may be dry or blister. Some types of targeted therapy may cause dry skin, a rash, and nail problems. If you develop a rash, it is important to talk with your doctor before stopping targeted therapy.
What does immunotherapy rash look like? ›You may notice redness or a warm sensation like a sunburn before the rash begins. After several days, pimples and pus bumps appear, and the surrounding skin feels slightly tender. Rashes are usually mild to moderate. But some people have severe rashes that cause major physical and cosmetic discomfort.
What rash is associated with immunotherapy? ›The most frequent skin manifestations during immunotherapy include maculopapular rash, psoriasiform and lichenoid eruptions; they are usually mild and can be successfully treated with topical corticosteroids, but more diffuse and/or exfoliative patterns may need cancer treatment interruption.
Why does immunotherapy make you itch? ›In a study published this month in Communications Biology, researchers from the University of Tsukuba have determined that one unpleasant side effect of immunotherapy with PD-1 inhibitors, called "anti-PD-1 antibody-induced psoriasis-like dermatitis," is caused by inflammation resulting from high levels of a specific ...
What are the symptoms of immunotherapy toxicity? ›Toxicities from combination immunotherapy can range from skin rashes, mucositis and diarrhea to colitis, sepsis, hypothyroidism, hyperthyroidism, pneumonitis, myocarditis, arrhythmia, type 1 diabetes and hypophysitis. These can occur within weeks after initiation.
Can you have an allergic reaction to immunotherapy? ›Serious reactions to allergy shots are rare. When they do occur, they require immediate medical attention. Symptoms of an anaphylactic reaction can include swelling in the throat, wheezing or tightness in the chest, nausea and dizziness. Most serious reactions develop within 30 minutes of the allergy injections.
Can you have a reaction to immunotherapy? ›For patients receiving immunotherapy drugs that are given intravenously, the most common side effects include skin reactions at the site of the injection, such as pain, swelling, and soreness. Some immunotherapy drugs may cause severe or even fatal allergic reactions, though this is rare.
Can immunotherapy cause an autoimmune response? ›Immunotherapy may intensify autoimmune disease symptoms
“These drugs can cause inflammation throughout the body, so side effects involving organs can mimic autoimmune diseases like Crohn's disease, autoimmune hepatitis or pneumonitis,” Dumbrava says.
The most common type of drug reaction is hives, also known as urticaria. They are raised, swollen, red or flesh-colored bumps or welts that appear on the skin. They can take on many shapes and can be very itchy. They usually develop in groups and may cover large areas of skin.
Does targeted radiation have side effects? ›
The most common early side effects are fatigue (feeling tired) and skin changes. Other early side effects usually are related to the area being treated, such as hair loss and mouth problems when radiation treatment is given to this area. Late side effects can take months or even years to develop.
How long do the effects of targeted radiation last? ›Healthy cells that are damaged during radiation treatment usually recover within a few months after treatment is over. But sometimes people may have side effects that do not improve. Other side effects may show up months or years after radiation therapy is over.
What does chemo rash look like? ›The chemo rash typically looks like a group of small pimples and pus-filled blisters. People with this form of chemo rash may also experience pain and itchiness from the condition. Radiation dermatitis is often a side effect of receiving radiation treatment.