As cancer therapies continue to advance, so too does the need for dermatologists to recognise and manage the range of cutaneous adverse reactions that can accompany these treatments. Oncodermatology is a rapidly evolving subspecialty at the intersection of oncology and dermatology, focusing on the diagnosis and management of skin-related side effects of cancer therapy, many of which can significantly impact patients’ quality of life and adherence to treatment.
In this Q&A, Dr Jonathan Leventhal (Yale School of Medicine), a leading expert in the field, shares his insights into the most common dermatologic reactions to cancer therapies, their clinical implications and effective management strategies. He also discusses how immune-related skin toxicities can be addressed without compromising the efficacy of oncologic care.
Various inflammatory eruptions and pruritus are common from all types of cancer therapy. The type and severity of the rash depends on the oncologic treatment. For example, patients on targeted therapies which block EGFR (epidermal growth factor receptor) frequently present with acneiform eruptions and paronychia. Those on multikinase inhibitors commonly develop hand-foot-skin reactions with painful hyperkeratosis of the palms/soles impacting functionality and daily living. Immune checkpoint inhibitors may result in a variety of rashes, especially lichenoid, psoriasiform, eczematous eruptions, vitiligo and bullous pemphigoid. Patients on cytotoxic chemotherapy often present with alopecia, nail changes (onycholysis, paronychia) and toxic erythema of chemotherapy. Radiotherapy results in acute radiation dermatitis while chronic radiation changes can occur months to years later including fibrosis, pigmentary changes and telangiectasias.
High-grade rashes which are extensive in terms of body surface area and which impact patient’s quality of life (e.g. disrupting functional and activities of daily living) often result in a drug holiday or a dose reduction of cancer therapy. One of the missions of supportive oncodermatology is to alleviate these cutaneous toxicities, improve patients quality of life and allow patients to remain on their life sustaining cancer therapy whenever possible. While rare, severe cutaneous adverse reactions (SCARs), which are life-threatening, result in discontinuation of the oncologic therapy and need for alternative treatments.
The approach depends on grading/severity where low grade eruptions can be managed with skin-directed therapy, while higher grade rashes require dose interruption/reduction and more aggressive treatment (e.g. systemic steroids, targeted immunomodulators). Focusing on rash morphology can help guide management. Prompt diagnosis and intervention are key in mitigating the cutaneous toxicities and improving a patient’s quality of life.
Immune-related adverse effects from immune checkpoint inhibitors comprise various inflammatory eruptions and pruritus. Most cases respond to topical steroids and anti-pruritics, while severe cases may require the use of systemic steroids in the short-term; however, dermatologists have a large therapeutic armamentarium including targeted immunomodulators/biologics which have been increasingly utilized with high degrees of efficacy and safety in recalcitrant cases. These targeted approaches have proven to be incredibly effective and increase the chance for patients to remain on their cancer therapies.1
It is inspiring to see many dermatologists, oncologists, scientists and pharmaceutical companies across the world take an interest in developing novel strategies to prevent and treat cutaneous toxicities. I believe that pathogenesis-directed therapies and targeted agents will be available in the future to most efficiently treat cutaneous toxicities, especially those which are recalcitrant to standard first-line agents. I look forward to seeing clinical trials and prospective studies investigate novel agents, particularly for targeted therapies which frequently cause skin toxicities (e.g. EGFR, RAS [renin-angiotensin system] inhibitors).
References
Greenberg ABW, Valido K, Vesely M, Leventhal JS. The treatment of cutaneous immune-related adverse events from immune checkpoint inhibitors with biologic therapy: a single-institution retrospective study at a tertiary care cancer center. J Am Acad Dermatol. 2025;S0190-9622(25)00723-6. doi:10.1016/j.jaad.2025.04.075. PMID: 40345549.
More about Jonathan Leventhal
Dr Jonathan Leventhal is Associate Professor of Dermatology at Yale School of Medicine, Director of the Dermatology Residency Programme, and Director of the Oncodermatology Clinic at Yale Cancer Center, New Haven, CT, USA. His clinical expertise lies in the evaluation and management of dermatologic toxicities related to cancer therapies, including traditional chemotherapy, targeted and immune-based treatments, radiation therapy and stem cell transplantation.
Dr Leventhal is actively involved in collaborative research with oncology, pathology and immunology colleagues at Yale, with a focus on the clinical and histopathological characterisation of cutaneous adverse events, their underlying mechanisms, prognostic significance and impact on patient quality of life. He serves as institutional principal investigator on clinical trials investigating the pathogenesis of targeted therapy-related rashes and novel strategies for managing skin toxicities.
Disclosures: This short article was prepared by touchDERMATOLOGY in collaboration with Dr Leventhal. No fees or funding were associated with its publication.
Cite: Leventhal J. Oncodermatology: Managing cancer therapy–related skin toxicities to optimize cancer care. TouchDERMATOLOGY. 30 July, 2025
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