Brown, J., Su, Y., Nelleson, D., Shankar, P., & Mayo, C. (2016). Management of epidermal growth factor receptor inhibitor-associated rash: A systematic review. The Journal of Community and Supportive Oncology, 14, 21–28.

STUDY PURPOSE: To summarize epidermal growth factor receptor inhibitor (EGFRI)–induced rash management recommendations and evaluate the scientific evidence of these recommendations

TYPE OF STUDY: Systematic review

• FINAL NUMBER STUDIES INCLUDED = 59 
• TOTAL PATIENTS INCLUDED IN REVIEW = Not noted
• SAMPLE RANGE ACROSS STUDIES: Not noted
• KEY SAMPLE CHARACTERISTICS: Most articles reviewed were expert opinion. No patient demographics were noted in the article.

PHASE OF CARE: Active antitumor treatment

INTERVENTIONS: Most articles identified in their search recommended both topical and oral antibiotic treatments. All three randomized, controlled trials and five of seven studies with prospective designs supported their use. Other common drug interventions included topical corticosteroids and antihistamines.

EVIDENCE: In the 59 articles, a range of evidence sources were cited for rash management recommendations. The most common basis of evidence for recommendations was expert opinion.  

RASH SEVERITY: Data demonstrated a pattern of escalating rash management interventions by rash severity: Topical treatments are mostly recommended for grade 1 rash, oral treatments are recommended for grade 2 rash, and delay or dose interruptions are almost exclusively recommended for grade 3 rash.

VARIATION: Data also revealed that substantial variation exists in the recommendations for rash management. Twenty rash management interventions were reviewed, including oral and topical retinoids, benzoyl peroxide, salicylic acid, and vitamin K cream. Recommended treatments, including oral and topical antibiotics, may be indicated for various grades of rash.

PREVENTION: Three randomized, controlled trials evaluated the prevention of onset of EGFRI-induced rash by using oral antibiotic prior to rash onset. All studies found that preemptive oral antibiotics were well tolerated and showed signs of reducing severe skin toxicities; however, future studies are needed.

Most recommendations for EGFRI-associated rash management relied on expert opinion. Although differences in the rash management recommendations existed, it was generally agreed that interventions for the rash management was dependent on the rash severity. For mild (grade 1) rash, topical treatments were recommended. For grade 2 rash, oral antibiotics or corticosteroids were recommended. For severe (grades 3 and 4) rash, treatment with oral corticosteroids and dose interruptions and delays were recommended. Additional randomized, controlled studies are needed to evaluate preemptive versus reactive treatments for EGFRI-induced rash.

• No quality evaluation
• Most common source cited for recommendations was expert opinion

Various interventions are available for managing mild, moderate, and severe EGFRI-induced rash. Nurses need to assess patients who are receiving EGFR inhibitors for severity of skin rash. Also, nurses need to understand the variety of options for managing EGFRI-induced rash and collaborate with physicians to select an appropriate intervention.