 Dermatologic side effects. This short presentation is intended to inform you and your loved ones about strategies for managing the side effects associated with targeted therapies. This particular webinar will discuss the dermatologic side effects that may be experienced. These side effects affecting the skin and hair will vary from patient to patient and they will also vary depending on the specific targeted therapy that you are taking. The most common side effects that patients may experience are hand-foot syndrome, rash, photosensitivity, scars and sores that may take longer to heal, splinter-like lines under the nails, skin or hair color changes, alopecia or a thinning or loss of hair. Hand-foot syndrome may present with redness, tingling, numbness, swelling, pain or tenderness, dryness, blisters, calluses or cracking of the palms of the hands or the soles of the feet. As you can see in this slide, this patient has a lot of peeling of his skin and redness and callus formation and also on these slides, some breakdown of skin, callus formation, sore tender areas on the palms of his hands and the soles of his feet. These may present with a lot of pain. These symptoms will vary and patients may exhibit one or all of the symptoms. These symptoms may interfere with the patient performing activities of daily routine such as walking or being able to button close. You should inform your health care provider as soon as you experience any of these symptoms. The prevention and management of hand-foot syndrome. If a patient has pre-existing calluses, they may be more likely to develop hand-foot syndrome. They should have a pedicure prior to starting therapy to remove the existing calluses. If a patient is diabetic, they should consult with their physician prior to starting treatment and maintain good glycemic control. Notify your physician immediately with any signs and symptoms of skin breakdown or infection. The best prevention is to start keeping the skin well moisturized prior to or at least from the beginning of treatment by using lotions or creams. You may use such products such as bag balm, Avino, utterly smooth or utter cream, lube-derm, gold-bond lotion, aqua-4 or Vaseline. Avoid vigorous rubbing when applying the lotions or creams. You should not walk barefoot. You should wear comfortable loose-fitting shoes and socks. You may find gel insoles helpful or well-padded soft shoes that relieve painful pressure points. Don't expose your skin to heat or hot water. Avoid hot showers and washing dishes in hot water. Avoid vigorous exercise that may put pressure on sore and tender areas such as running, jogging, any kind of activity with gardening or repetitive activity of the hands that may put pressure on these sore areas. Avoid tight dressings, band-aids, or adhesive tape to skin. You may find that soaking your hands and feet in lukewarm water several times per day helps to alleviate some of the symptoms. You should keep your legs raised whenever possible. If calluses develop use urea-containing lotions such as carousel, carol, or carallac. These lotions should be applied only to the callus area. Some patients have found that placing their affected areas on an ice pack or on cool water relieves some of the symptoms. You should alternate this on and off 10 to 15 minutes at a time. Use pain relievers as needed. Tylenol may provide pain relief or you may need to speak to your health care provider about another type of pain reliever. Topical steroids may be indicated such as Reginocare or lidocaine. If peeling and cracking skin occurs, watch for signs of infection and you may need a consult with dermatology or a podiatrist if your symptoms are interfering with activities of daily routine. Rash is another side effect that some patients may experience. The rash may vary significantly on the type, the time of onset, severity, duration, and response to therapeutic intervention. Typically the rash consists of papules which are elevated areas of skin without fluid or macules which are flatter areas of skin color change covered with small bumps. The most commonly affected areas are face, the scalp, trunk, and extremities. Some patients may have extreme itching with their rash. The management of rash you should use gentle soaps without fragrance, Cedophil skin cleanser, Neutrogena, or Vino shower gel. You should keep your skin well hydrated by drinking a lot of fluids and also keeping your skin moisturized by applying moisturizing lotions frequently such as bag bomb, a Vino, utterly smooth lanolin, or a Eucerin. Avoid hot showers, avoid the sun, but if you are in the sun apply sunscreen frequently. You may need to use over-the-counter antihistamines to relieve itching. You may also need to use some type of topical steroid or antibiotics. You would need to check with your health care provider for these. Other skin issues, burning or itching scalp, you might need to use anti-dandruff shampoo or extremely dry skin. Skin color changes such as you might notice a yellowish tone to your skin. You would need to inform your health care provider about this jaundice so that a blood test could be done to determine if the skin coloration is due to liver damage or drug-induced skin discoloration. Photosensitivity, you may find that your skin is more sensitive to sun burning. The sunlight may also cause a skin rash. You should avoid sun lamps or tanning beds and wear protective clothing when outdoors. You may find that your skin appears to be more thin and more susceptible to bruising and tearing. So you'd want to use caution and not injure yourself easily. Scars and sores may take a longer time to heal. Some patients have also noticed a splinter-like lines developing under their nail beds. This symptom is not usually associated with pain or change in nail integrity. However, if you do experience pain, you should consult with your health care provider. This does not require treatment. Hair color changes. Some patients have experienced hair color changes or depigmentation, loss of color in their hair while taking these therapies. These changes seem to be most noticeable on patients who are on a taking therapy, which involves a break or a rest period during the cycle of therapy. As you can see in this patient, she had hair color changes during the time that she was on therapy. Then on the two weeks rest period, her hair color returned to normal. These hair color changes may occur on facial hair, eyebrows, mustache, beards, as well as the hair on your extremities. Again, it is most noticeable during treatment cycles that involve a rest period. As you can see in slide E, the hair loss occurs during treatment and returns to normal during the two weeks that the patient is on a rest or off therapy. These changes are reversible and will return to normal after treatment is discontinued. This does not require treatment, but may affect how you feel about your appearance. Alopecia is a loss or thinning of hair. It may involve only thinning or it may involve complete loss of hair. It can occur on all parts of the body, head, face, beard, as well as extremities. This does not usually happen right away, but may start about 7 to 21 days after the start of treatment. It is almost always temporary. However, when your hair grows back, it may have a different color or texture. The management of alopecia, you need to be gentle when washing your hair. You need to pat your hair dry. Avoid items that could injure your scalp, such as a straightening or curling iron, brush, rollers, or curlers, or an electric hair dryer. You should avoid hair dyes or products to perm or relax the hair. And you might try sleeping on a satin pillowcase, as satin creates less friction than cotton and protect your scalp when outdoors. In summary, you should communicate with your doctor or nurse when side effects occur so they can evaluate and help to manage your symptoms. Preventive care management can minimize the severity of symptoms and increase treatment compliance and quality of life.