Maculopapular Skin Rashes Associated With High-Dose Chemotherapy: Prevalence and Risk Factors
Purpose/Objectives: To determine the prevalence of and risk factors for maculopapular skin rashes associated with high-dose chemotherapy.
Design: Observational pilot study.
Setting: A bone marrow transplant hematology-oncology unit in a private city hospital.
Sample: Data were collected on 14 patients who developed maculopapular rashes out of 127 patients who received high-dose chemotherapy (purposive sampling).
Methods: Observation of the distribution and nature of skin rashes in relation to chemotherapy, disease, adjuvant medications, and white blood cell counts.
Main Research Variables: Diseases, chemotherapy protocols and doses, adjuvant medications, and blood counts.
Findings: Skin reactions ranged from mild, scattered macular or maculopapular rashes to severe rashes. Patients newly diagnosed with acute myelogenous leukemia (AML) who received induction protocols containing cytarabine had the most rashes, affecting 6 of 11 patients (55%). No rashes were observed on patients treated with the protocol that included high-dose corticosteroids. Patients rarely had recurrence of the rash with further courses of chemotherapy.
Conclusions: Cytarabine doses higher than 700 mg/m2 may be a cause of maculopapular skin rashes. Patients most at risk were those newly diagnosed with AML who received induction therapy. Corticosteroids may prevent the development of skin rashes.
Implications for Nursing: No useful nursing strategy exists to prevent, lessen the intensity of, or shorten the course of a delayed hypersensitivity rash. Knowing which patients are most at risk is useful to enable close monitoring and patient and staff education.
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References
Apisarnthanarax, N., & Duvic, M. (2000). Dermatologic complications of cancer chemotherapy. In R.C. Bast, Jr., D.W. Kufe, R.E. Pollock, R.R. Weichselbaum, J.F. Holland, & E. Frei (Eds.), Cancer medicine (5th ed., pp. 2271-2278). Ontario, Canada: B.C. Decker.
Armstrong, T., Rust, D., & Kohtz, J. (1997). Neurologic, pulmonary, and cutaneous toxicities of high-dose chemotherapy. Oncology Nursing Forum, 24(1, Suppl.), 23-33.
Barton-Burke, M., Wilkes, G., & Ingwerson, K. (Eds.). (2001). Cancer chemotherapy: A nursing process approach (3rd ed.). Sudbury, MA: Jones and Bartlett.
Coombs, P.R., & Gell, P.G. (1968). Classification of allergic reactions responsible for clinical hypersensitivity and disease. In R.R. Gell (Ed.), Clinical aspects of immunology (pp. 575-596). Oxford, United Kingdom: Oxford University Press.
Edwards, S.J. (2003). Prevention and treatment of adverse effects related to chemotherapy for recurrent ovarian cancer. Seminars in Oncology Nursing, 19(3, Suppl. 1), 19-39.
Fitzpatrick, T.B., Johnson, R.A., Wolff, K., Polano, M.K., & Suurmond, D. (Eds.). (1997). Color atlas and synopsis of clinical dermatology common and serious diseases (3rd ed.). Carlisle, MA: McGraw-Hill.
Gallagher, E. (2001). Management of a widely disseminated skin rash. Clinical Journal of Oncology Nursing, 5, 279-280.
Gallagher, J. (1995). Management of cutaneous symptoms. Seminars in Oncology Nursing, 11, 239-247.
Goldsmith, L.A., Lazarus, G.S., & Tharp, M.D. (1997). Adult and pediatric dermatology: A colour guide to diagnosis and treatment. Danvers, MA: F.A. Davis.
Gravett, P. (2001). Aromatherapy in the treatment of skin problems developing as a result of high dose chemotherapy. International Journal of Aromatherapy, 10, 132-134.
Haisfield-Wolfe, M.E., & Rund, C. (2002). The development and pilot testing of a teaching booklet for oncology patients' self-assessment and perineal skin care. Journal of Wound, Ostomy, and Continence Nursing, 29(2), 88-92.
Hockett, K. (2004). Stevens-Johnson syndrome and toxic epidermal necrolysis: Oncologic considerations. Clinical Journal of Oncology Nursing, 8, 27-30, 55.
Keung, Y.K., Knovich, M.A., Powell, B.L., & Pettenati, M. (2004). Acute myelocytic leukemia with rare t(2;11)(q13;p13), skin rash, and fever of unknown origin. Cancer Genetics and Cytogenetics, 148, 89-90.
Kossard, S. (2000). Dermatologic complications. In K. Atkinson (Ed.), Clinical bone marrow and blood stem cell transplantation (2nd ed., pp. 993-999). Cambridge, MA: Cambridge University Press.
Marks, R. (1993). Roxburgh's common skin diseases (16th ed.). London: Chapman and Hall Medical.
McCarthy, A. (2002). The nursing management of cutaneous toxicities of chemotherapy: A review of current evidence. Australian Journal of Cancer Nursing, 3(2), 17-20.
McKay, L.I., & Cidlowski, J.A. (2000). Corticosteroids. In R.C. Bast, Jr., D.W. Kufe, R.E. Pollock, R.R. Weichselbaum, J.F. Holland, & E. Frei (Eds.), Cancer medicine (5th ed., pp. 732-740). Ontario, Canada: B.C. Decker.
Pearson, I.C., Sirohi, B., Powles, R., Treleaven, J., & Mortimer, P.S. (2004). The impact on resources of prevalence and nature of skin problems in a modern intensive haemato-oncology practice. Hematology, 9, 415-423.
Pichler, W.J. (2003). Delayed drug hypersensitivity reactions. Annals of Internal Medicine, 139, 683-693.
Rest, E.B., & Horn, T.D. (1992). Dermatology. In J.O. Armitage & K.H. Antman (Eds.), High-dose cancer therapy pharmacology, hematopoietins, stem cells (pp. 519-530). Baltimore: Williams and Wilkins.
Sauer, G., & Hall, J. (1996). Manual of skin diseases (7th ed.). Philadelphia: Lippincott-Raven.
Schaich, M., Schakel, K., Illmer, T., Ehninger, G., & Bornhauser, M. (2003). Severe epidermal necrolysis after treatment with imatinib and consecutive allogeneic hematopoietic stem cell transplantation. Annals of Hematology, 82, 303-304.
Sewell, W.A. (2000). Immunology update. In K. Atkinson (Ed.), Clinical bone marrow and blood stem cell transplantation (2nd ed., pp. 99-110). Cambridge, United Kingdom: Cambridge University Press.
Tse, E., Lie, A., Ng, I., & Kwong, Y. (2003). Fatal skin rashes and myalgia in a leukaemic patient. Haematologica, 88(2), EIM02.
Zurcher, K., & Krebs, A. (1992). Cutaneous drug reactions: An integrated synopsis of today's systemic drugs. Basal, Switzerland: Karger.