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Cetuximab

Skin, hair and nail care advice

This leaflet is to guide you in looking after your skin, hair and nails. It also offers advice if symptoms become worse, whilst on Cetuximab

Cetuximab rashes tend to be papulopustular, eg; pus filled blemishes , like acne, which are worse at the start of treatment, in the first few weeks, but generally improve over time. 

You may develop :

  • A papulopustular rash – redness, flushing, pus filled blemishes, like acne.
  • Itching ( pruritis)
  • Dry skin ( xerosis)   
  • The rash or dry skin is usually on the face, neck, chest and back.
  • If the skin becomes inflamed, you may be at risk of skin infection.
  • Sometimes the rash and / or dry, itchy skin can be painful
  • The scalp may become dry and sore, and you can develop a rash in the scalp also
  • Patients can develop sore eyes and eye infections
  • Eyelashes may grow longer and thicker and may curl and twist, over time 
  • There may be more hairs growing on your body and face also.
  • The tips of the fingers and toes may develop fissures or cracks, which can be deep and painful at times
  • You may develop nail bed infections

 

Skin care management :

Please follow the advice below:

  • Wash in tepid water
  • Use a soap alternative, for example : Oilatum, Hydromol or Dermol wash.
  • We would normally use Oilatum , and only try hydromol or dermol wash if this is not helping
  • Pat dry, do not rub the skin
  • Use moisturisers all over the body after washing, before bed and as needed, during the day : such as aveeno 
  • If oat allergy, try balneum plus or cetraben
  • If Aveeno doesn’t help, we can try Cetraben or an alternative cream
  • Wear loose clothing: cotton or linen
  • Do not wet shave, use electric razor
  • Avoid sun, heat, wind and cold exposure
  • Use factor 50 SPF sun cream, after applying moisturizer.
  • Avoid scented laundry detergent
  • Avoid alcohol skincare products.
  • Avoid over the counter products
  • Avoid tight fitting shoes, avoid friction and pressure on the nail fold.
  • Increase the fluid intake and keep well hydrated

 

What to do if the rash /skin becomes more itchy, red or inflamed

  • If the area becomes very itchy and aveeno or other creams are not helping, we can try hydrocortisone 1% cream, applied sparingly to the area twice daily.
  • If the area is inflamed and red, we can then try clindamycin gel sparingly to the affected area, apply twice daily. 
  • If the area is hot to touch and red or inflamed, or you have a temperature above 37.5, ring the treatment helpline, to assess for skin infection:

Telephone Velindre: 029 20615888 , and ask for the treatment helpline

 

What to do if you have pain, with the rash or dry skin:

If you have red skin (erythema), inflammation, or severe itching, this may become painful.

If the rash is painful, consider paracetamol to help

If the pain is localized or becomes more severe, hot and inflammed, or you have a temperature, ring the treatment helpline, as this could suggest a possible skin infection, such as cellulitis.

We can sometimes use an antimicrobial cream, for example dermol lotion to help with the skin irritation.

 

How to manage lesions in the scalp and itchy scalp :

  • Wash in simple shampoo
  • We can prescribe betnovate twice daily, if the scalp is sore and very itchy.

 

What to do if you develop fissures (cracks or splits in the fingers or toes)

Fissures generally appear after 2 to 4 months of treatment.                                                    They can sometimes cause pain and impairment on your function, which may impact on your activities of daily living and quality of life. 

Fissures appear as painful cracks or splits, especially on the heels and fingertips.

We can try a hydrocolloid dressing, for example: duoderm thin over the affected area

Sometimes superglue can help also. It is important to use an unopened tube of superglue and keep for the fissures only

 

What if you develop nail bed infections:

Patients may experience pain, inflammation, discharge, swelling, fissuring, cracking or ridging of nails or a granuloma in the nail bed

 

If you develop these symptoms, ring the treatment helpline

We can try Trimovate, a combined topical steroid / antibiotic / antifungal cream to the nail bed.

Sometimes we may need to use oral antibiotics.

Helpful tips to protect your nail beds

  • Add vasoline to cuticles of hands and feet
  • Wear gloves for washing up
  • Avoid tight fitting shoes/gloves

 

How to manage curly, long, eyelashes: 

Trim the eyelashes regularly when they start to grow longer.