Reactive Management

Principle of Treatment Escalation

At the time of the creation of this website (2009), there were no evidence-based guidelines for the management of dermatological toxicities associated with EGFRI treatment. Treatment algorithms described on this website are, therefore, compiled from a review of the literature or based on reported expert guidance and anecdotal or small-series case reports.

[Update: In 2011, the MASCC published a Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities .]

Treatment decision-making requires careful diagnosis of the particular clinical situation. The information provided on this website may serve as one tool among others to help you in treatment decision-making.

Treatment for the Different Symptoms

General Recommendations

  • General measures for skin hydration, sun protection and nail care1
  • Early intervention2,3,4: Start treatment at the first sign of rash; treat pain early, look for cracked skin, or oozing from the rash

Mild Grade 1 Acneiform Rash Treatment Recommendations1

  • Topical metronidazole cream

Associated with symptoms1,2,4

  • Paronychia : Antiseptic soak/cream, topical ultrapotent steroid
  • Pruritus : Moisturising/cooling cream
  • Fissures : Moisturising ointment

Continue with EGFRI treatment

Moderate Grade 2 Acneiform Rash Treatment Recommendations1

  • Add oral tetracycline
  • Add S. aureus-spectrum antibiotics in case of superinfection

Associated with symptoms1,2,4

  • Paronychia : Add oral tetracycline, topical silver nitrate
  • Pruritus : Add oral antihistamines
  • Fissures : Add liquid bandages, analgesics

Continue with EGFRI treatment, monitor carefully

Severe Grade 3 Acneiform Rash Treatment Recommendations1

  • Double the tetracycline dose
  • Use saline compresses
  • Add S. aureus-spectrum antibiotics for superinfection
  • Monitor carefully

Associated with symptoms1,2,4

  • Paronychia : Add S. aureus spectrum antibiotics for superinfection
  • Pruritus : Add sedative antihistamines
  • Fissures : Add S. aureus spectrum antibiotics for superinfection

Withhold EGFRI treatment, re-treat only if symptoms moderate (eg grade ≤2)


1Segaert S. Targeted Oncol 2008; 3: 245-251.
2Sipples R. Semin Oncol Nurs 2006; 22: 28-34.
3Lacouture ME. Nat Rev Cancer 2006; 6: 803-812.
4Rhee J et al. Clin Colorectal Cancer 2005; 5(Suppl 2): S101-S106.