Cutaneous drug reactions in oncology: clinical session with Dr Ellene Papazis in Porto

On 1 March 2025, a clinical session on cutaneous drug reactions took place at the Hotel Mercure Porto, in Gaia. The session was led by Dr Ellene Papazis, a dermatovenereologist and member of the team at the Portuguese Institute of Oncology (IPO Porto). The event brought together around 50 health professionals from the north of the country, in a meeting marked by the sharing of clinical experience and current knowledge.

Dr Ellene Papazis trained in Dermatology at the Instituto de Dermatologia Professor Rubem David Azulay, in Rio de Janeiro, where she completed her specialisation in dermatovenereology. She subsequently undertook subspecialisation in Oncological Dermatology at the Instituto Nacional de Câncer (INCA), with an emphasis on cutaneous manifestations associated with cancer therapy. With more than 15 years of clinical practice, she has established herself as a reference in cutaneous toxicity associated with oncological treatment.

What are cutaneous drug reactions?

Cutaneous drug reactions in oncology — also called adverse cutaneous drug reactions — are manifestations on the skin, mucous membranes, hair or nails caused by the toxic or immune-mediated action of medication. In the oncological context these reactions are particularly relevant, given the potency and complexity of the therapies used: chemotherapy, immunotherapy, targeted therapies and radiotherapy.

They can include:

• Xerosis and pruritus, which affect the skin barrier and cause continuous discomfort

• Hand-foot syndrome (palmar-plantar erythrodysaesthesia), common in patients on capecitabine or sorafenib

• Acneiform eruptions, frequent with epidermal growth factor receptor (EGFR) inhibitors

• Chemotherapy-induced alopecia, one of the most visible manifestations and with high psychological impact

• Nail changes, ranging from discolouration to painful onycholysis

The frequency and severity of these reactions vary with the type of drug, the dose and individual predisposition. Recent studies indicate that up to 40% of patients on oncological therapy develop some degree of cutaneous toxicity. Moreover, many of these reactions appear to be associated with better tumour response, which increases the dermatologist's responsibility in balancing oncological efficacy against the patient's quality of life.

Radiation dermatitis, for example, can occur in more than 80% of patients with head and neck cancer undergoing radiotherapy. Studies show that topical moisturising care and clinical surveillance reduce its severity and prevent interruption of therapy.

Early recognition and multidisciplinary action are fundamental in avoiding serious complications such as secondary infection, severe pain, or even suspension of the oncological treatment.

A commitment to education and quality of life

The session led by Dr Ellene Papazis highlighted not only the clinical aspects of cutaneous drug reactions but also practical strategies for prevention and early intervention. An integrated dermato-oncological approach, considering the physical and emotional impact of cutaneous manifestations, is essential to ensure that patients can continue their cancer treatment safely and with dignity.

References

• Cury-Martins, J., et al. (2020). Management of dermatologic adverse events of oncologic therapies: expert panel recommendations. Anais Brasileiros de Dermatologia, 95(2), 221–237. doi:10.1016/j.abd.2020.01.001

• Criado, P. R., et al. (2010). Adverse cutaneous reactions related to antineoplastic agents — Part I. Anais Brasileiros de Dermatologia, 85(4), 425–437.

• Emvalomati, A., et al. (2023). Narrative Review of Drug-Associated Nail Toxicities in Oncologic Patients. Dermatology: Practical & Conceptual, 13(1), e2023064. doi:10.5826/dpc.1301a64

• Naidoo, J., et al. (2015). Toxicities of the anti-PD-1 and anti-PD-L1 immune checkpoint antibodies. Annals of Oncology, 26(12), 2375–2391. doi:10.1093/annonc/mdv383

• Tsai, P. C., et al. (2023). Clinical effect of moisturized skin care on radiation dermatitis. In Vivo, 37, 2776–2785. doi:10.21873/invivo.13389

• Venturi, F., et al. (2024). Cutaneous Toxicities of Advanced Treatment for Cutaneous Melanoma. Cancers, 16(3679). doi:10.3390/cancers16213679

• Wikramanayake, T. C., et al. (2020). Alopecia in Cancer Patients. Journal of Clinical Aesthetic Dermatology, 13(6), 12–20.

• Zhang, S., et al. (2023). Cutaneous immune-related adverse events are associated with longer overall survival. JAAD, 88(5), 1024–1032. doi:10.1016/j.jaad.2022.12.048