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Tarceva Rash - some hopefully helpful hints

amymaura
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Last week I was in Philadelphia at the Oncology Nursing Society’s annual congress. I attended a session called Dermatologic Toxicities of Chemobiotherapy. The main presenters were a dermatologist who treats lots of people with “Tarceva rash” and rashes from other targeted therapies and a nurse from Dana Farber who discussed various case studies of these rashes, and what they did to address them. She treats mostly non-small cell lung cancer patients so it was very relevant.

A lot of the session had to do with why these rashes happen from a biological perspective, but a good part was dedicated to HOW to deal with them. In addition to Tarceva, people who are on Iressa or Erbitux may also experience a rash.

They did confirm that the rash IS indeed a good indicator that the medicines are working.

So, they divided the types of skin conditions into 4 categories:

1. Papular/pustular rash (which seems to be common in this community.
2. Dry skin (as in SEVERLY dry skin)
3. Nail alterations (splitting, for example)
4. Hair abnormalities (such as thinning, loss, excessive growth of eyelashes and eyebrows)

I should mention that a lot of this is written in a journal article that was published a year ago in the journal The Oncologist. You can read the article here: http://tinyurl.com/5ly9yj

One of the main points Dr. Lacouture (the dermatologist and co-author of this article) mentioned is that early intervention is key, to the point that he thinks a standard protocol for these drugs should involve paying attention to the skin before the rash even develops. The nurse recommended starting out early by switching to mild soaps like Cetaphil or Neutrogena, and using a good moisturizer on the body such as Lubriderm, Neutrogena, Oil of Olay and using face moisturizers such as those made by Neutrogena, even before the rash starts to show up. (I promise, none of these companies are paying me to plug their products! These were the brands that the nurse mentioned, so I wrote them all down). She also mentioned the importance of a good cover-up – both for women and men who are feeling self-conscious about the rash. Two that she mentioned as having good coverage as well as moisturizing are Clinique and Clarins. She actually tested out tons of cover-ups and found these to be the best. She also mentioned using Johnson and Johnson baby oil spray to get areas on your back that you can’t reach.

Next, once you have the rash, there are several approaches depending on how bad it is. In general there are two things that docs use for the rash part. 1. Topical steroids and 2. Oral antibiotics.

For a mild rash, he recommended topical hydrocortizone 2.5% or clindamyacin 1%. I know there are some topical cortizone creams that you might use, but I think he was referring to prescription strength creams. If the skin does not respond to the topical steroids, or if the rash is severe, a short course of antibiotics, such as tetracycline or doxycycline, is recommended. If there’s still no change after two weeks, they recommend dose modification if the rash is still unbearable. The nurse also talked about recommending to a patient that he use benedryl spray for the itch.

If you have problems with scalp scaling, the dermatologist recommended Capex shampoo, which seems to be use for seborrheatic dermatitis and severe dandruff, or Olux foam, used to treat psoriasis. I googled both and found them both. They are both prescription medicines. He also mentioned the importance of sunscreen that blocks both UVA and UVB rays.

If you have splitting of the fingertips or toes, the nurse recommended Hibiclens, which is an antiseptic, antimicrobial skin cleaner. I found it for sale on drugstore.com. There’s also Bactroban, which is an ointment by prescription only that is a topical antibiotic.

The bottom line is talk to your doctor as soon as you start seeing the rash. Do not assume that you have to try to deal with it on your own. See if your oncologist can refer you to a dermatologist to discuss options for treating it. There are things that can help, and you should absolutely not wait until it is painful and debilitating before taking action.

Hope this is helpful. I'll be at ASCO in another week and a half (that's the American Society of Clinical Oncology) and I will try during the few weeks after to summarize what I think is useful from the sessions.

If anyone has any questions about any of this, I am happy to try to answer them. Just send me an email.

Best wishes,

Amy

View 6 replies

Explore topics in this discussion:

Cancer MRSA Atarax Doxycycline Psoriasis Skin conditions Dermatitis Rashes Pain Tarceva Bactroban Benadryl Lung cancer

6 replies

Marylou1

Hi Amy:

I wish you could send this info to my Oncologist. The care of my skin has been just research on my own. As you can see with my picture, I had a Grade 4 rash when I first started with Tarceva. My doctor never warned me about a rash, just said I might get a few zits but that would not ruin my social life.

I was on my own on a weekend with face pain so bad that I was using cold packs. I finally searched online and found almond oil and Eucerin Cream in the jar, the heavy stuff. I immediately sent my hubby out and he did find them, the cream at Walmart and the almond oil at the health food store.

I cannot tell you how badly I suffered until I was able to see my doctor on the following Thursday. I had to stop the Tarceva, and was on an antibiotic from my family doctor for another problem. By the time I saw my Oncologist, my face was beginning to get better.

Please allow me to add to what you have learned about care of Tarceva skin whether it's Zits or any other. I do wash with a mild soap, and exfoliate with a gentle exfoliater. While my face is still wet, I put the almond oil on and let it soak in. After it has then I apply the Eucerin cream. Believe me, it was a life saver and I have been using it ever since.

My Oncologist was very Anal about giving out RXs for Clindamycin gel or Minocycline. I got them from my family doctor, and by using all of these, I have been able to keep the rash under control.

One thing I learned very quickly about any kind of moisturizer is that if it has an odor, don't use it, it will burn. As far as make up is concerned, Mary Kay Day Radiance not the liquid, is the best make up to cover this rash or anything else.

I should take another picture and change it so everyone can see the difference.

I sure hope this helps someone. I was grateful to find some online info when this first happened.

Thanks for your help.

Marylou

amymaura

Hi Mary Lou,

From the sounds of it, too many oncologists disregard the importance of the skin rash, which is ridiculous. The presenters said that of people taking Erbitux, 80-90% will get a rash, and of people on Tarceva and Iressa, 60-70% will get a rash. And that rash can (as you and others know) seriously interfere with quality of life. Your picture is very similar to other pictures that the presenters showed.

It sounds like you have found things that have worked so thanks for adding them to this string! Hopefully others will benefit!

Amy

J-me

Thanks for this info. I wish I had known prior to beginning my treatment. I investigated with many different products and spents hundreds of dollars trying to find the ones that worked for me. The products I use for maintenance now are not on your list but they have managed to keep my skin hydrated.
Origins brand-Never Say Dry Face Moisturizer and Precipitation Plus lotion for my body. I still have minor outbreaks and when that happens I use minocycline to get it under control. My skin for the most part looks very healthy.

When speaking with the researcher that worked with Tarceva, he stated that the rash usually lasts about 8 months but then becomes very manageable. Hopefully, this will encourage people to stay on the drug if they are having benefit from it.

Thanks again for the info. Amy

God Bless!!
J-me

Pbishop619

Hi Amy,

I was on Tarceva for 18 months and had grade 4 rash and had to take breaks from the medication 2 times and dropped the dose from 150 to 100 which helped a lot. I have to say I agree with what you write 100% - you really have to be ahead of the rash - I did find the almond oil and Eucerin (Wal-Mart brand) to be the best to keep me moisturized. At one point I was putting moisturizer on my stomach and legs every time I went to the bathroom as they were extremely dry to the point of bleeding. One thing I did find helpful is I started taking a shower every other day and when I did take a shower I put baby oil gel all over my body BEFORE I got my shower that way when I started washing the baby oil would wash away not my oil and I never used much more than warm water. My skin peeled like I had a really bad sunburn, in fact I looked really tan - I still have the look of a suntan even on the chemo I am on now and I never go in the sun I us 50 SPF sunblock. I was fortunate that my oncologist worked with me and gave me whatever medication he thought would help my skin, I was on Minocycline, Clindamycin lotion , Hydrocortisone cream, Benadryl cream, Sarna Lotion, Aquaphor and Atarax for itching. For me the itching is what got so out of control and I was taking 300mg of Atarax per day 100mg 3x a day the Hydrocortisone cream and Benadryl cream didn't do much for the itching but the Sarna lotion and Aquaphor helped a lot - I mixed them together to make a really nice moisturizer and it helped a lot - the Sarna lotion feels good on itchy skin and the Aquaphor stays on a long time so the 2 together work well together When I bothered with make up I usually used Dermablend it really covers well but then I have to work to remove it when I wash my face - I was used to wearing such a light foundation prior to this I wore mineral make up and just brushed a little one here and there - so the Dermablend made me feel like I was wearing a mask - but I think that is because I feel like I had so much to cover up - my skin was really broke out on my face - I am happy to say now that I am off the Tarceva I have very clear skin on my face. I just hope I find something that works as well for me as the Tarceva did.

Pamee

NikkiF

There's also an over the counter product called StaphAseptic (Rite Aid, Walgreens, CVS etc) that is a bactericide. The great thing about it is that it kills germs including MRSA (antibiotic resistant staph infections). It helps wounds heal and it also contains a painreliever.

Tinkerbellmom

I use almond oil and Eucerin ( jar) and has worked well for me. Tarceva recommends Lindi products that are too expensive. I have also used plain old honey..I just rub it it and about an hour later I wash it off..sounds weird but it is an anticbacterial! See the dermatlogist, Good Luck doris

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