Rash Management - Episode 11

Side Effect Management With Corticosteroids

Kathryn Ciccolini, RN, BSN, OCN, an oncology nurse at Memorial Sloan-Kettering Cancer Center, discusses the use of corticosteroids to treat the side effects associated with targeted cancer therapies.

Many patients are prescribed topical corticosteroids to address some of the side effects associated with therapy. These adverse events run the gamut and induce rashes, hand-foot skin reactions, pruritis, photosensitivity, and symptomatic scars. In general, topical corticosteroids carry an excellent safety record and have been in use for about 50 years, Ciccolini says.

It is important to monitor and evaluate each patient before prescribing these medications, Ciccolini says. Additionally, patients should be educated on general indications for prescribing topical steroids, such as decreasing inflammation, immunosuppressive, vasoconstrictive, and antiproliferative therapy.

The typical frequency for treatment with topical steroids is twice daily for two to four weeks with one week of rest to prevent tachyphylaxis, Ciccolini suggests. A high potency steroid, such as clobetasol, should not be used at a dose higher than 45 to 60 grams per week. If the patient finds that they are using more than this, they should be encouraged to call their dermatologist’s office for reevaluate.

The overall potency of the topical steroid and the need to avoid use in intertriginous areas should be explained upon the start of therapy, Ciccolini explains. Local applications site side effects with these treatments include burning, stinging, itching, cracking of the skin, fissuring of the skin, dryness, erythema, irritation, or papular rash. Prolonged use of steroids can cause skin atrophy, telangiectasias, striae, hypertrichosis, and pigmentation changes, Ciccolini adds.

The patient’s allergies and medications should be reviewed, to avoid adverse reactions, Ciccolini states. Unless indicated in the treatment plan, the patient should be instructed to avoid applying occlusive dressings, since this may increase percutaneous absorption.