FAQs - Fast Facts (Rash)
Question: Are antibiotics (systemic or topical) useful in the treatment of rash associated with cetuximab therapy?
Answer: Antibiotics are useful only in the management of secondarily infected rash and thus should be prescribed when indicators of infection are observed. Characteristics of secondary infection include yellowish-brown crust overlying inflammatory lesions, oozing of fluid from lesions, or an abrupt change in appearance of lesions. Infections should be treated with a short course of oral antibiotics such as minocycline, to which Staphylococcus aureus responds reasonably well. Consider a pustule culture to further determine the offending infectious agent if antibiotic resistance is suspected. Topical antibiotic therapies, including clindamycin, have been used to treat infections, although to date no controlled trials have investigated their effectiveness in rashes caused by HER/EGFR inhibitors.1
Figure 1.
Photo courtesy of Pamela Hallquist Viale.
The rash associated with cetuximab is usually noted within the first 2 weeks of therapy and is located on the face, scalp, and upper torso, but occasionally it may extend to the arms and legs. It is sterile, suppurative, and characterized by multiple pustular or papular lesions. It often resolves when treatment is stopped.2
Oncology nurses should use the National Cancer Institute Common Toxicity Criteria, version 3, when grading lesions associated with cetuximab therapy to help guide their patients toward appropriate therapy. It is important to describe lesions accurately when assessing the extent or presence of the rash. Recommended terms include pustular-papular rash, pustular eruption, or follicular and intrafollicular pustular eruption.1
Nurses need to instruct their patients to avoid exposure to sunlight and harsh detergents and soaps that may aggravate rash symptoms.3 Patients need to be taught to contact their physician, nurse practitioner, or nurse if they develop significant skin rash, skin discomfort such as pruritis or pain, or exudative lesions.2 Click here for more about Skin Rash.
A patient education brochure and provider poster on management of rash associated with EGFR targeted therapy is available for download and/or online printing without charge from The Oncologist. The items are best printed on a color printer and can be accessed at http://theoncologist.alphamedpress.org/cgi/content/full/12/5/610/DC1. This link is provided for informational purposes only. The product package insert should be consulted as the definitive resource for management of EGFR-related skin toxicities..
Bulk copies can be ordered directly from The Oncologist using an order form available through the above link. The brochure and poster are based on an article by Lynch et al. Epidermal growth factor receptor inhibitor-associated cutaneous toxicities: An evolving paradigm. The Oncologist 2007;12:610-621. The abstract is available at http://theoncologist.alphamedpress.org/cgi/content/abstract/12/5/610.
References
- Perez-Soler R, Delord JP, Halpern A, et al. HER1/EGFR inhibitor-associated rash: future directions for management and investigation outcomes from the HER1/EGFR inhibitor rash management forum. Oncologist. 2005;10:345-356.
- Wilkes G. Therapeutic options in the management of colon cancer: 2005 update. Clin J Oncol Nurs. 2005;9:31-44.
- Thomas M. Cetuximab: adverse event profile and recommendations for toxicity management. Clin J Oncol Nurs. 2005;9:332-322. [ Pub Med ]
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