When you’re diagnosed with cancer, a trip to the dermatologist may be the furthest thing from your mind. For many patients and oncologists, preserving skin health has not necessarily been the highest priority. Instead, their focus was right where it should be on saving patients’ lives. However, skin-related conditions that coincide with cancer treatments are common, so developing a clear plan to prevent, diagnose, and treat these concerns is essential. This need led to the development and exploration of a field of medicine you may not be familiar with – oncodermatology. Dr. Sam Awan of Center for Dermatology in Plano and McKinney, TX., is one of few dermatologists in the Dallas metroplex and across the country who has taken the time to study the diagnosis and treatment of skin conditions related to cancer, and currently offers oncodermatology services in partnership with oncologists for cancer patients across the DFW Metroplex and the U.S. Keep reading to learn more about oncodermatology.
The word oncodermatology itself offers some explanation of the word’s meaning. “Onco” means relating to tumors, and it is typically used in the medical field as part of words describing cancer treatments. Dermatology is the field of medicine that provides treatment for diseases and conditions that affect the skin. Oncodermatology refers to the diagnosis, treatment, and management of skin conditions that develop in relation to cancer treatments.
A Brief History of Oncodermatology in the U.S.
While chemotherapy has been used as part of cancer treatment for several decades now, the dermatologic subfield of oncodermatology is relatively new. In the early 2000s, cancer specialists began to use newer forms of treatment, including targeted blockers and immunotherapies. According to Dr. Awan, “These newer targeted therapies started causing unique, predictable, and treatable skin side effects.” In response to these new common adverse effects on the skin, dermatologists and oncologists found themselves working together more and more often with the same goal in mind – preserving skin health to optimize patient care outcomes.
In the mid-2000s, major academic institutions across the US began forming specialized oncodermatology clinics. The purpose of these clinics is to find effective treatments to restore skin health, so patients can continue their cancer therapy. As oncodermatology continues to grow and evolve, it remains essential to keep patients on their oncology treatments if at all possible. According to Dr. Awan, “In this way, oncodermatology can have a tremendous impact on prolonging lives and on these patients’ quality of lives.”
Why is Oncodermatology necessary?
Dr. Awan describes the necessity of oncodermatology by saying, “As dermatologists learned more about these new treatment-induced rashes, we discovered that patients were often taken off their potentially lifesaving treatments prematurely due to the uncomfortable nature of these rashes.” The most important role of dermatologists who provide oncodermatology treatments is to provide a quick and effective assessment to help determine whether or not it is safe for the patient to continue treatment. Dr. Awan explains, “Most skin side effects from these newer cancer treatments can be co-managed by a dermatologist along with your cancer doctor, but some cases are severe enough to require a break in treatment.” You’ll need to be examined by a dermatologist to help you determine what type of skin condition you’re looking at and create a treatment plan.
Is My Rash Chemo-Related or Another Type of Skin Condition?
If you have a chronic skin condition like eczema, psoriasis, or acne before you begin chemotherapy, you may find the cancer treatments exacerbate these pre-existing conditions. In order to determine whether the cancer treatment is a direct cause of your skin symptoms, you’ll need to visit a skilled dermatologist, preferably one who has experience with oncodermatology who will partner with you to create a treatment plan.
Symptoms of Chemo-Related Rashes
When you visit a dermatologist who specializes in oncodermatology, they will need to carefully review your current situation to determine what, if any, treatment is necessary. Treatment-related rashes can take many different forms, including:
- Dryness and itching – nearly all targeted cancer therapies are capable of causing itching and skin dryness.
- Vitiligo – white patches of depigmented skin. Depending on the cancer treatment that causes this reaction, these patches may indicate a good response to cancer treatment
- Acneiform – although not the same as common acne, many cancer treatments can cause head and neck breakouts that look similar to acne
- Eczematous – these types of rashes are caused by inflammation, and they may lead to itching, redness, and sores that seep fluid.
- Psoriatic – like the scaly, patchy skin rashes that occur due to psoriasis, these rashes are often painful and very itchy.
- Blisters – skin filled with serous fluid that can be very painful, especially if the skin is punctured to release the serous fluid.
The Assessment Process
To understand your condition, we’ll need to perform a thorough assessment, which usually involves the following steps:
- A historical timeline of which cancer treatments you have been through, and when each treatment was started
- An assessment of the severity of your symptoms and the impact on your quality of life
- A detailed physical examination of the skin, looking for color, size, location, and specific characteristics of the rash
- A skin biopsy (a quick, small, virtually painless in-office procedure) may be necessary to further characterize the type of skin eruption you are having
- These questions and the physical examination will help us determine whether or not your skin condition is directly related to your chemotherapy treatments before we begin to grade your skin conditions and plan treatment.
The Grade of Severity
Patients who visit an oncodermatologist will have their skin symptoms evaluated using a grading system. According to Dr. Awan, “These rashes have a very specific system for grading severity. This grading system allows us to determine when we can keep patients on their oncology treatments and medications and when we need to interrupt therapy.”
Should I Visit a Dermatologist During Treatment?
According to Dr. Awan, “Adverse skin responses can occur days to months after starting a new oncology medication. The key is that if a patient is on a newer targeted therapy or immunotherapy and develops any dermatologic side effects, they should be referred to a dermatologist. With certain types of treatments like EGFR inhibitors, it’s beneficial to see a dermatologist shortly before beginning treatment, because studies have shown several preventative strategies we can begin prior to the cancer treatment.” Together, the oncologist and oncodermatologist can partner to keep patients healthy in order to allow them to continue their oncology treatments safely. When in doubt, schedule an evaluation with a dermatologist.
Almost any of the new cancer drugs can cause skin rashes. However, some of the common drugs that are implicated in connection with adverse skin responses include:
- EGFR inhibitors like erlotinib and gefitinib
- CTLA-4 and PD-1 inhibitors like nivolumab, pembrolizumab, and ipilimumab
- BRAF inhibitors like vemurafenib, dabrafenib
Common Oncodermatology Treatments
Depending on the grade assigned to your condition and your unique needs, we may recommend a range of treatment options. The really important thing for oncology patients to understand, according to Dr. Awan, is that “In many cases, there are easy ways to treat these newer rashes.” Treatment plans may include:
- For lower grade skin conditions, we’ll work through your at-home care routine. We may also recommend the use of topical anti-inflammatory creams.
- For more advanced skin conditions, we’ll usually combine topical ointments and steroidal creams with the use of oral antibiotics and other medications as well as pain management.
- Severe cases may require hospitalization and extended invasive and noninvasive procedures to maintain health, but these are very rare overall.
Contact U.S. Dermatology Partners
If you’re in need of dermatological treatment during chemotherapy, don’t hesitate to contact Dr. Awan and the team at Center for Dermatology in Plano or McKinney, TX. If you’re not located in the DFW Metroplex, a skilled dermatologist in one of our other local offices will be happy to help. Simply fill out our online form to give us the information necessary to connect you with an oncodermatology specialist in your area.
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