ONS Connect - June 2008 - (Page 23)

table 1. incidence of Dermatologic Reactions Associated With eGFR inhibitors Adverse Event Rash (follicular-pustular) Paronychia and fissuring Dry skin Mucositis Hair changes Hypersensitivity reactions Note. Based on information from Eaby et al., 2008. Figure 1. Guidelines for Patients Using eGFR inhibitors Frequency (%) 60–80 6–25 4–35 2–36 5–6 2–3 • Remain hydrated. • Avoid long, hot showers; instead, use lukewarm water and mild soap. • Use an alcohol-free emollient all over the body twice a day to prevent dry skin. • Use dye-free, alcohol-free, and perfume-free products (e.g., lotions, soaps, shampoos, laundry detergents). • Hypoallergenic makeup can be used to conceal the rash, but be sure to remove it daily using a mild cleanser. • Use an adequate amount of sunscreen with SPF 30 or higher and protective clothing, including a broad-brimmed hat, when going outside. • Use of a saline nasal spray and petroleum jelly may reduce the risk of nosebleeds. • To prevent nail problems, keep finger- and toenails clean and trimmed. Avoid biting nails, using artificial nails, or wearing tight-fitting shoes or socks. Moisturize the hands and feet frequently; petroleum jelly is particularly effective and can be applied throughout the day and at night. Note. Based on information from Eaby et al., 2008; Oishi, 2008. lar in nature (Eaby et al., 2008). In the past, clinicians also have referred to the rash as “acneform,” but use of this term is discouraged because patients may attempt to use common acne treatments (e.g., benzoyl peroxide) for it, which exacerbate the symptoms (Oishi, 2008). Mild, grade 1 rash (papulopustular) usually can be managed with topical hydrocortisone or clindamycin. Moderate, grade 2 rash (papulopustular with pruritis) often is treated with hydrocortisone, clindamycin, or pimecrolimus, with the addition of an oral antibiotic such as doxycycline or minocycline. For severe skin toxicity, grade 3 or 4 rash, treatment may require EGFR inhibitor dose reductions. Patients should receive the same treatment for moderate rash but with the addition of a methylprednisolone dose pack. If symptoms still do not resolve, interruption of EGFR inhibitor therapy may be required. However, treatment may be resumed at a lower dose after the rash has improved (Eaby et al., 2008; Oishi, 2008). The use of pimecrolimus or tacrolimus for EGFR inhibitor–associated rash has been explored; however, the drugs are immunosuppressants, so they are not recommended for immunosuppressed patients (Eaby et al., 2008). Patients also may find that over-the-counter antihistamines (e.g., diphenhydramine) and analgesics (e.g., ibuprofen) are helpful and can use them at any time (Oishi, 2008). Other Skin Conditions Patients may experience other conditions in addition to rash, such as dry skin, itching, and increased sun sensitivity. For dry, itchy skin, patients should be instructed to use alcohol-free emollients such as Aquaphor ® (Beiersdorf AG) or Aveeno® (Johnson & Johnson). Gentle exfoliants also may be helpful for scaly areas. Because skin toxicities can increase patients’ sun sensitivity, patients should be instructed to avoid sun exposure. If they must be in the sun, they should wear protective clothing and use a broad-spectrum sunscreen containing zinc oxide or titanium dioxide. Other guidelines for patients using EGFR inhibitors can be found in Figure 1. For more information on skin toxicities related to EGFR inhibitors, refer to the full articles by Oishi (2008) and Eaby et al. (2008). ✱ Eaby, B., Culkin, A., & Lacouture, M.E. (2008). An interdisciplinary consensus on managing skin reactions associated with human epidermal growth factor receptor inhibitors. Clinical Journal of Oncology Nursing, 12(2), 283–290. Retrieved May 13, 2008, from http://ons .metapress.com/content/bu37k6201n07322n/ fulltext.pdf Oishi, K. (2008). Clinical approaches to minimize rash associated with EGFR inhibitors. Oncology Nursing Forum, 35(1), 103–111. Retrieved May 13, 2008, from http://ons.metapress.com/ content/r3316472g81r3777/fulltext.pdf June 2008 ONS CONNECT 23 http://ons.metapress.com/content/bu37k6201n07322n/fulltext.pdf http://ons.metapress.com/content/bu37k6201n07322n/fulltext.pdf http://ons.metapress.com/content/bu37k6201n07322n/fulltext.pdf http://ons.metapress.com/content/r3316472g81r3777/fulltext.pdf http://ons.metapress.com/content/r3316472g81r3777/fulltext.pdf

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ONS Connect - June 2008 Contents Editor's Note Just In They Have a Dream A Year in the Life—Month Six Web Connect Capitol Connection Notice Nursing Now Caregiver Care Manage Skin Toxicities Associated With EGFR Inhibitors Blood Test for Ovarian Cancer May Be 99 Percent Accurate Calendar of Events Working For You Staying On Top

ONS Connect - June 2008

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