Rash lasts the first 6 weeks.
Intensity of rash correlates with efficacy
STEPP trial was the first prospective trial which showed a benefit with 6 weeks of doxycycline or minocycline to prevent grade 2 or higher rash.
CTC criteria using BSA may not apply. Another risk stratification is used specific for EGFR Ab.
Flowchart for grades of toxicity and management
Grade 1 : mild pustular with no other symptoms.
Rx: topical clinda 2% with hydrocortisone 1% apply BID lotion ( although generally speaking refrigerated emollient alcohol free cream is better for the rest of the body).
Grade 2: Moderately symptomatic, moderate pustular with erythema, may or may not interfere with ADL
As with grade 1 + oral doxy until rash resolution+ for scalp lesions clinda with triamcinolone
Grade 3: Moderate to severe intolerable rash, interferes with ADL
"Several situations warrant patient referral to a dermatologist. Clinicians may wish to refer if the skin toxicity does not improve within 1–2 weeks of treatment. Referral is also recommended if the patient is severely symptomatic (for example, if necrosis, blistering, or petechial or purpuric lesions are present) or if multiple hair, nail, and skin issues emerge 29. In general, if the skin toxicity has an uncharacteristic appearance or distribution (it just doesn’t look “right” or familiar), it is advisable to refer the patient to a dermatologist."
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