Xerosis and Pruritus

Skin xerosis associated with itching during polychemotherapy for colon cancer.

Symptoms/signs

66-year-old male patient.
The subject reports dry skin that appeared about three months ago, associated with persistent itching symptoms for a few weeks.

Patient photographs

 

Clinical presentation

Examination of the entire skin area revealed xerosis of the skin on the limbs – particularly on both legs – showing extensive signs of scratching.

Medical history

The patient has metastatic adenocarcinoma of the colon for which he was initially treated with capecitabine and is currently on the combination of FOLFOX (FOLinic acid, Fluorouracil, OXaliplatin) + bevacizumab.

Differential diagnosis

  • Drug-induced cutaneous xerosis

  • Asteatotic eczema

  • Impetigo

  • Contact dermatitis (irritative or allergic)

Diagnostic tests

A thorough inspection of the entire skin area reveals potential signs suggestive of possible differential diagnoses: inflammation resulting from alteration of the mechanical barrier is responsible for erythema and oedema associated with asteatotic eczema; observation of impetigo scabs suggests impetiginisation; blister formation or lichenification are typical of contact dermatitis.

Description of the disease

Xerosis is a common skin side effect during cancer therapy: when combined with targeted therapies against EGFR or VEGF, the onset is delayed, occurring after many weeks of treatment, and the condition is more pronounced in the first three months. According to some experiences reported in the literature, up to two thirds of subjects with colorectal cancer undergoing treatment with the FOLFOX + bevacizumab combination experience this manifestation, with varying degrees of intensity, and symptoms that are either absent or characterised by itching and stinging pain. It is useful to recognise and correct any external factors that may aggravate skin xerosis, such as, in particular, excessively dry outdoor or indoor environments and excessive exposure to water and soaps/surfactants.

Pharmacological treatment and patient instructions

Pharmacological treatment and patient instructions
The basis of treatment consists of the systematic application of emollients to cover the skin surface; in the event of inflammation, combination with a medium or high potency topical corticosteroid is recommended. In addition, taking an oral antihistamine is useful for quickly reducing itching symptoms.
In this case, the following was recommended:

Cetirizine 10 mg tablet, locally in the evening for 30 days

Dermocosmetic management 

  • LIPIKAR Syndet AP+, an ultra-gentle cleansing cream suitable for sensitive skin prone to itching, for specific daily cleansing, in combination while limiting the number and duration of baths/showers

  • avoid sudden changes in temperature and exposure to sunlight

  • avoid the use of cosmetic products containing fragrances or alcohol

Follow-up (adjuvant treatment outcomes)

The patient was reassessed after approximately 4 weeks: a physical examination of the skin showed improvement of the skin condition, with disappearance of the excoriated lesions that had been noticeable during the previous visit. Although these reactions are limited to the skin, rapid recognition and specific management of xerosis resulting from chronic cancer therapy has a substantial impact on daily quality of life and treatment tolerability, with the aim of avoiding potentially harmful dose reductions or discontinuation.