Different types of immunotherapy work in different ways. EGFR inhibitors are routinely used to treat advanced malignancies such as colorectal cancer and lung cancer. Because of their mechanism of action and the targets they attack, they are very often associated with the development of dermatological adverse effects, which need to be understood and managed.  Symptoms and esthetic issues can both have a major impact on patients’ quality of life. Patients’ personal, social, and workplace relationships can be affected. 

EGFRI-related adverse events

Cutaneous complications are the most frequent adverse side effects of EGFR inhibitors, occurring in up to 90% of patients treated with cetuximab therapy, with grade 3–4 adverse events occurring in 11–18% of treated individuals. The most common dermatologic adverse events caused by EGFR inhibitors include characteristic papulopustular eruptions, dry and itchy skin, hair changes, mucositis, nail changes, and photosensitivity. 

Symptoms

Anti-EGFR drug-related symptoms:

• Papulopustular eruption 
• Nail changes
• Xerosis
• Pruritus
• Mucositis 
• Photosensitivity
• Radiation Dermatitis

Prevention

General recommendations for all individuals undergoing treatment with EGFRIs should include gentle and dry skin care recommendations, as well as adequate sun protection. A cross-sectional survey study concluded that individuals undergoing cancer therapy may benefit from fewer complications by avoiding prolonged hot showers, which should be a part of general dry skin care prevention recommendations. Patients should be advised to use a daily moisturizer, with creams favored over lotions, as well as sunblock with a sun protection factor (SPF) of at least 30. Any skin care products should be unscented and detergents that are used to wash clothes should be scent-free and dye-free.