Drug eruptions associated with tumor therapy: Great Imitators

Abstract Many studies have investigated cutaneous reactions to anti-tumor drugs and found them to be quite numerous. We describe drug eruptions that may be associated with different therapies by class; anti-metabolite chemotherapeutics, genotoxic agents, spindle inhibitors, signal transduction inhibitors, and immunotherapies. Methotrexate is most often associated with mucocutaneous reactions, alkylating anti-metabolite agents with hyperpigmentation, and platinum anti-metabolite agents with Type I IgE-mediated hypersensitivity reactions. Anthracycline derivatives can induce the hand-foot syndrome in patients, and bleomycin is associated with a bleomycin-induced flagellate erythema. Taxane spindle inhibitors can result in acneiform eruptions, which may also be seen with use of EGFR inhibitors. Imatinib and its derivitives can cause a truncal maculopapular eruption, while ultikinase inhibitors can produce a hand-foot-skin reaction. Verumafenib can result in squamous cell carcinomas and photosensitivity. First generation mTOR inhibitors may cause a maculopapular eruption initially involving the face and neck. PD-1-ligand and receptor inhibitors are both associated with bullous pemphigoid. Ipilimumab, targeting CTLA-4 receptors can cause a morbilliform reaction, while IL-2 analogs can create the capillary leak syndrome. Chemotherapeutic drug eruptions classically can manifest in the aforementioned ways; however, it is important to understand that they are associated with myriad cutaneous adverse effects, which may be mistaken for organic skin disease. Oncologists prescribing these medications should be familiar with the cutaneous side effects of these medications, so that they may counsel patients to be on the look out for them.