Side Effect: Skin flaking

Skin flaking is a condition where the skin sheds or peels off in small or large pieces. It is usually caused by a loss of moisture in the skin, leading to dryness and irritation. Skin flaking can occur anywhere on the body, but is most common on the face, scalp, hands, and feet.

• Flaking skin may appear as dry, rough patches or scales that are white, gray, or tan in color.
• Mild cases may cause small flakes or dry patches on the skin with slight irritation or itching, while more severe cases can lead to larger areas of peeling skin and cause discomfort or even pain.
• The texture of the skin can also be affected, with flaky skin feeling rough or bumpy to the touch.

Patients with cancer undergoing radiation therapy or chemotherapy can experience damage to the skin, causing dryness, irritation, and flaking.
Some targeted therapies that can commonly cause skin toxicities, including flaking skin, include:

EGFR inhibitors:

• Caprelsa® (vandetanib)
• Erbitux® (cetuximab)
• Gilotrif® (afatinib)
• Iressa® (gefitinib)
• Nerlynx® (neratinib)
• Portrazza® (necitumumab)
• Rybrevant® (amivantamab)
• Tarceva® (erlotinib)
• Tagrisso® (osimertinib)
• Tykerb® (lapatinib)
• Vectibix® (panitumumab)
• Vizimpro® (dacomitinib)

VEGF inhibitors:

• Inlyta® (axitinib)
• Cabometyx®, Cometriq® (cabozantinib)
• Votrient® (pazopanib)
• Stivarga® (regorafenib)
• Nexavar® (sorafenib)
• Sutent® (sunitinib)

MEK inhibitors:

• Mekinist® (trametinib)
• Mektovi® (binimetinib)
• Cotellic® (cobimetinib)

mTOR inhibitors:

• Afinitor® (everolimus)
• Torisel® (temsirolimus)

Retinoids:

• Vesanoid® (tretinoin, ATRA)

• Maintaining adequate hydration and moisturizing the skin regularly can help to prevent dryness and flaking.
• Patients should avoid exposure to extreme temperatures and wear protective clothing and use sunscreen when outdoors.
• Avoid using harsh soaps or hot water and use gentle, fragrance-free products instead.

Treatment options for skin flaking in patients with cancer may include:

• topical moisturizers
• emollients
• barrier creams to soothe and protect the affected skin.

Common medicated creams that are used include ammonium lactate and salicylic acid.

In more severe cases, the causative agent may need to be stopped and use of topical steroids may be necessary.