SKIN/ NAIL PIGMENTATION CHANGES


TYPE OF TREATMENT PROACTIVE
(PREVENTION/STEP 0) 		REACTIVE
(MANAGEMENT IN CASE OF AE)
  • Conventional chemotherapy
  • Antimetabolites (5-FU etc.)
  • Alkylating agents (cyclophosamide, cisplatin)
  • Mitotic inhibitors (taxanes, vinca alkaloids)
  • Cytotoxic (bleomycin)
  • EGFR/HER inhibitors
  • Capecitabine
  • Multikinase, checkpoint inhibitors
  • MEK/BRAF/VEGFR inhibitors
  • Gentle cleanser with pH ~ 5
  • Sun avoidance: especially direct sun at mid-day
  • Sun protection when outside with UV broadspectrum UVB/UVA SPF 50 or greater sun-screens and strong UVA protection, especially with targeted therapy; clothing, sunglasses, and hats; patients with darker phototypes are at higher risk for PIH
  • Reapply sunscreen q2h
  • Opaque nail lacquers
  • Avoid heat, humidity
  • Continue Step 0
  • Dermocosmetics containing niacinamide
  • Topical corticosteroids
  • Hydroquinone for hyperpigmentation (limited to 6 months of use maximum)