Blog

Normally, people who are going to receive chemotherapy treatment are not entirely clear about the side effects they may suffer.

In this article, we would like to provide information on some of the symptoms that may appear during treatment, as well as a series of recommendations that will help you to cope with them and reduce them.

Most frequent side effects

We are going to focus on some of them, but we recommend you to visit the most frequent side effects of chemotherapy that you can find in the web page of the Spanish Association Against Cancer.

Skin dryness or xerosis

A frequent effect due to chemotherapy or targeted antitumor therapies is the appearance of dryness and/or intense itching of the skin. The most frequent areas where it appears are the face, trunk, legs and distal areas of the fingers.

Dryness or xerosis of the skin generally appears 20 days after the start of treatment. There may be risk factors such as advanced age, history of atopic eczema and previous use of conventional chemotherapy.

To combat it, it is essential to take extreme hygiene and skin care measures. Excessive hygiene should be avoided and shower oil should be used instead of more aggressive soaps or gels for the skin. Moisturizing or emollient creams on demand and topical corticosteroids are indicated in the most intense cases and always under dermatologist supervision.

Periungual skin inflammation (Paronychia)

It is characterized by inflammation of the lateral nail margins with local swelling and sometimes ingrown nails or formation of local granulation tissue, pyogenic pseudogranulomas or true abscesses.

Sometimes there is breakage of the affected nails. The most frequently affected nails are those of the feet, especially the first toe.

Paronychia may be accompanied by pain and bleeding and may interfere with activities of daily living as well as require affected patients to wear special footwear.

The appearance of lesions is later than the other adverse effects, with an average of 2 months after starting treatment. In some patients they even appear 4-6 months after treatment. The lesions resolve upon discontinuation of treatment and even in some cases despite treatment.

Treatments for these lesions are diverse and the results are variable. Astringent ointments, topical mupirocin, corticosteroids associated with a topical antifungal, silver nitrate, antiseptics alone or in combination with topical corticosteroid are used to treat this problem depending on the situation.

Acneiform type drug eruption or folliculitis type rash

This type of rash is common in epidermal growth factor (EGFR) inhibitors. EFGR plays a crucial role in the normal functioning of the skin and hair follicles.

The main manifestation of this cutaneous side effect is folliculitis. These are red, pustular lesions centered by the hair. The most frequent location is the face, scalp, shoulders, thorax and upper dorsal area.

It is true that there seems to be a correlation between the intensity of folliculitis and the clinical response of the patient. That is, the greater the skin reaction, the better the tumor response to the drug. Thus the acneiform reaction is very useful to guide the clinician on the response to treatment.

Acneiform lesions may itch but mostly cause cosmetic discomfort and may therefore lead to non-compliance with treatment. It is important for patients to be aware of this common adverse effect and to treat lesions at an early stage, as they respond better to dermatological treatment. Close follow-up of these patients over time is also necessary. As general measures , it is recommended to avoid photoexposure, high temperature and high humidity.

When lesions are asymptomatic, but cause cosmetic discomfort, camouflage techniques can be used, preferably with fat-free products. If there is itching and inflammation we can use treatments with topical and oral antibiotics as well as corticosteroid creams always under prescription of the dermatologist/oncologist.

Hand-foot syndrome or palmoplantar erythrodysesthesia

Acral erythema, or hand-foot syndrome or palmoplantar erythrodysthesia, is a relatively frequent cutaneous reaction produced by different chemotherapeutic agents.

It presents as redness and pain in palms and soles associated with alterations in sensitivity in the context of oncological treatment.

Hand-foot syndrome appears to be dose-dependent, whereby the maximum drug level in the blood as well as the cumulative dose of the chemotherapy drug determine its occurrence.

The most frequent agents involved are doxorubicin, 5-FU and derivatives, cytarabine and docetaxel.

It usually begins 24-48 hours after the administration of chemotherapy and is maintained for the duration of the treatment, resolving two weeks after the end of the treatment and repeating after new cycles.

Symptomatic relief has been obtained by wound care to prevent infection, elevation of the limbs to reduce edema, cold packs, emollients, topical antibiotics and analgesics. Cooling of hands and feet during chemotherapy administration and the following days has been used with partial success in the prevention of docetaxel-induced hand-foot syndrome and may reduce the severity and frequency of liposomal doxorubicin-associated AE, although its usefulness has not been scientifically proven. It also seems advisable not to do heavy manual labor or excessive walking and to avoid local heat.