“Chemo acne” is a common skin reaction associated with certain targeted cancer therapies, particularly those that inhibit the epidermal growth factor receptor (EGFR). This issue is technically an acneiform eruption, meaning it is a rash caused by drug-induced inflammation, not the clogged pores and bacterial overgrowth of typical acne. The rash appears as red papules and pus-filled pustules, which can cause significant discomfort. Effective management requires understanding that this is not true acne, as standard acne products often worsen the condition. Specialized treatment is necessary to soothe the inflammation and minimize interruption to the patient’s cancer regimen.
Understanding the Skin Reaction
The rash is a direct result of targeted cancer drugs disrupting the normal function of skin cells. The epidermal growth factor receptor is present on many healthy skin cells, including those in the hair follicle, and its inhibition triggers an inflammatory cascade. This process leads to the formation of sterile, inflamed bumps that lack the blackheads and whiteheads characteristic of acne vulgaris. The rash typically emerges within the first few weeks of starting therapy, often peaking around three to four weeks. It most frequently affects the face, scalp, neck, chest, and upper back, areas rich in hair follicles.
Gentle Topical Management
The cornerstone of at-home care involves maintaining a gentle, consistently hydrating skincare routine to support the compromised skin barrier. Cleansing should be limited to once or twice daily using a mild, non-foaming, and pH-neutral cleanser. Use only fingertips and warm water, avoiding abrasive cloths or sponges. Moisturize immediately after washing while the skin is still damp. Thicker, fragrance-free creams or ointments are preferred over lighter lotions as they create a more robust barrier against moisture loss. Products must be free of alcohol, perfumes, and other known irritants, since chemotherapy sensitizes the skin.
Medical and Prescription Interventions
When the rash is moderate to severe, or when gentle topical care is insufficient, professional medical intervention is necessary. The treating oncologist or a specialized dermatologist may prescribe medications to manage the inflammation and prevent secondary infection. A common approach involves oral antibiotics from the tetracycline class, such as doxycycline or minocycline. These medications are used primarily for their strong anti-inflammatory effects, not just for their antibacterial properties. Proactively starting oral doxycycline before the rash appears can significantly reduce the incidence and severity of the eruption. For active rash management, low-potency topical corticosteroids, like 1% hydrocortisone cream, are often prescribed.
Prevention and Ongoing Skin Care
Proactive measures started before and continued throughout therapy can minimize the severity of skin reactions. Aggressive hydration, both internally and externally with emollients, should begin before the first treatment session. Protecting the skin from the sun is mandatory, as EGFR inhibitors significantly increase photosensitivity. Patients should apply a broad-spectrum sunscreen with an SPF of 30 or higher daily and wear protective clothing. Patients often experience other skin-related side effects, such as paronychia, which is inflammation around the fingernails or toenails. Keeping nails short and avoiding excessive pressure or friction can help manage these associated issues.