Skin Changes - Dry Skin


Dry skin is also referred to as xerosis or xerosis cutis, and typically manifests with flaky, dull, scaly, and itchy skin.1-3 pruritus (itching) is a symptom of dry skin.1


Dry skin is commonly seen in patients treated with some multikinase inhibitors, occurring in 7% to 17% of patients treated with either sorafenib, vandetanib, sunitinib, or imatinib.4-8 In addition, eczema is reported in 2% of patients treated with sunitinib.7


Dry skin with multikinase inhibitors tends to appear 2–3 months after the initiation of therapy and is persistent, often lasting for several months.11-13 Onset of pruritus occurs alongside the onset of xerosis.


Dry skin associated with multikinase inhibitor therapy is reported to not be cumulative, is typically reversible, and generally does not require treatment discontinuation.7 Also see management of skin changes, pruritus.

Grading and Lesion Characteristics

According to the NCI-CTCAE V4.03,9 dry skin is, “A disorder characterised by flaky and dull skin; the pores are generally fine, the texture is a papery thin texture”. The NCI-CTCAE V4.03 uses the term dry skin, whereas the MESTT10 classification uses the term cutaneous xerosis.

Grade 1 (mild) Dry Skin

  • The NCI-CTCAE V4.03 definition of grade 1 dry skin reads: Covering <10% BSA and NO associated erythema or pruritus
  • The MESTT definition of grade 1 xerosis reads: Scaling/flaking NO erythema/pruritus/effect on emotions or functioning

Grade 2 (moderate) Dry Skin

  • The NCI-CTCAE V4.03 definition of grade 2 dry skin reads: Covering 10-30% BSA and associated with erythema OR pruritus; limiting instrumental ADL
  • The MESTT definition of grade 2A xerosis reads: Scaling/flaking + pruritus OR effect on emotions/functioning
  • The MESTT definition of grade 2B xerosis reads: As 2A + erythema

Grade 3 (severe) Dry Skin

  • The NCI-CTCAE V4.03 definition of grade 3 dry skin reads: Covering >30% BSA AND associated with pruritus; limiting self-care ADL
  • The MESTT definition of grade 3A xerosis reads: As 2B + fissuring/ cracking
  • The MESTT definition of grade 3B xerosis reads: As 3A + signs of superinfection


1Lacouture ME, et al. Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities. Support Care Cancer. 2011;19:1079–1095.
2Robert C, et al. Cutaneous side-effects of kinase inhibitors and blocking antibodies. Lancet Oncol. 2005;6:491-500.
3Chanprapaph, K, et al. Epidermal Growth Factor Receptor Inhibitors: A Review of Cutaneous Adverse Events and Management. Dermatology Research and Practice. 2014;2014:1-8.
4European Medicines Agency. Nexavar® (sorafenib) Summary of Product Characteristics 2014.
5European Medicines Agency. Caprelsa® (vandetanib) Summary of Product Characteristics 2014.
6Food and Drug Administration. Caprelsa® (vandetanib) Prescribing Information 2014.
7European Medicines Agency. Sutent® (sunitinib) Summary of Product Characteristics 2014.
8European Medicines Agency. Glivec® (imatinib) Summary of Product Characteristics 2014.
9National Cancer Institute Cancer Therapy Evaluation Program. Common Terminology Criteria for Adverse Events and Common Toxicity Criteria [v4.0]. 15-12-2010. (accessed 22 August 2014)
10Multinational Association of Supportive Care in Cancer (MASCC) EGFR Inhibitor Skin Toxicity Tool (MESTT) (accessed 22 August 2014)
11Belum VR, Fischer A, Choi JN, Lacouture ME. Dermatological adverse events from BRAF inhibitors: a growing problem. Curr Oncol Rep. 2013;15:249–259.
12Manousaridis I, et al. Cutaneous side effects of inhibitors of the RAS/RAF/MEK/ERK signalling pathway and their management. J Eur Acad Dermatol Venereol. 2013;27:11–18.
13Robert C, et al. Advances in the management of cutaneous toxicities of targeted therapies. Semin Oncol. 2012;39:227–240.

Last update: 22 August 2014