EGFR-targeted therapies (including EGFR-TKIs and EGFR antibodies) have significantly prolonged survival in various solid tumors such as lung cancer, head and neck cancer, and colorectal cancer. Their efficacy is well established. However, side effects—particularly cutaneous toxicities—pose a major threat to patients’ quality of life, sometimes forcing dose reductions or even treatment discontinuation. This article has been revised from the perspective of Hong Kong patients, emphasizing “prevention first, response second”, and provides practical answers to common patient concerns and management strategies.

Side Effects and Management Strategies of EGFR Targeted Therapy

Hong Kong patients’ perspective: Prevention first, timely response, maintaining treatment adherence and quality of life.

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EGFR-targeted therapies (including EGFR-TKIs and EGFR antibodies) have significantly prolonged survival in various solid tumors such as lung cancer, head and neck cancer, and colorectal cancer. Their efficacy is well established. However, side effects—particularly cutaneous toxicities—pose a major threat to patients’ quality of life, sometimes forcing dose reductions or even treatment discontinuation.
This article has been revised from the perspective of Hong Kong patients, emphasizing “prevention first, response second”, and provides practical answers to common patient concerns and management strategies.

Background and Purpose

Overview of Side Effects and Timeline

Cutaneous toxicities occur in 60–90% of patients and include acneiform papules/pustules, xerosis with pruritus, paronychia, mucositis, hand–foot syndrome, and hair changes (Gloucestershire Hospitals NHS Trust; CancerConnect; U.S. Pharmacist).
The most common is the acneiform rash, appearing in about 70% of patients within 1–2 weeks after initiation, mainly affecting sebaceous gland–rich areas such as the face, scalp, chest, and back (Gloucestershire Hospitals NHS Trust; NCODA; The ASCO Post).
If neglected, these rashes may worsen, leading to infections and jeopardizing treatment adherence (NCODA; SpringerLink).

Strategy-Oriented Approach: Prevention First, Rapid Response

(1) Pre-emptive Measures

All patients initiating EGFR inhibitors should adopt preventive strategies, including:

Daily use of broad-spectrum sunscreen SPF ≥ 15 → 30 to prevent UV-induced or aggravated skin reactions (MIMS; The ASCO Post; NCODA).
Use of gentle cleansers and fragrance-/alcohol-free moisturizers, e.g., Aveeno, Epimax emollients, or Cetaphil-type products (Gloucestershire Hospitals NHS Trust; Oncology Nursing Society; CancerConnect).
Daily application of emollients as a foundation for skincare (Oncology Nursing Society; CancerConnect).
Oral tetracycline-class antibiotics (e.g., doxycycline 100 mg/day) starting from week 1 of treatment can significantly reduce ≥Grade 2 rash incidence and improve quality of life (Gloucestershire Hospitals NHS Trust).

This “pre-emptive” strategy offers Hong Kong patients clear guidance, helping them make rational decisions and take proactive protection.

(2) Reactive Management

Mild Rash (Grade 1)	Continue current medication + apply topical corticosteroid (hydrocortisone) and topical antibiotic (clindamycin 2% + hydrocortisone 1%) concurrently for 4 weeks, according to Alberta Health Services. If no improvement is observed, escalate management.
Moderate Rash (Grade 2)	Continue current medication + topical corticosteroid + topical antibiotic + oral doxycycline or minocycline 100 mg twice daily for 4 weeks, based on Alberta Health Services, The ASCO Post, and Oncology Nursing Society guidelines.
Severe Rash (Grade 3)	Recommend treatment interruption for 2 weeks or until rash improves to Grade ≤ 1, then resume EGFR inhibitor. Continue topical corticosteroid and oral antibiotic; short-term oral corticosteroid (e.g., prednisone 0.5 mg/kg for 7 days) may be considered, according to The ASCO Post.
Paronychia / Nail Inflammation	Prevention focuses on moisturizing surrounding cuticles; management includes warm soaks, topical antibacterial/antifungal ointments, or oral antibiotics. In cases of severe granulation or edema, silver nitrate, cryotherapy, or electrocautery may be considered, according to CancerConnect and MIMS.
Xerosis / Skin Fissures	Enhance skin hydration with moisturizers and emollients; apply low-potency topical corticosteroids when needed. Oral antihistamines may also be used for itching relief, according to CancerConnect and Gloucestershire Hospitals NHS Trust.
Hair Changes	Use moisturizing shampoo products. For eyelash trichiasis, trimming or ophthalmology referral may be required, based on Biology Insights and CancerConnect.
Severe or Suspected Infection	Prompt referral to dermatology specialists for precise diagnosis and possible tissue culture is recommended to avoid delayed management, according to Alberta Health Services, MIMS, and Biology Insights.

Key Takeaways (Hong Kong Patient Perspective)

Effective management of cutaneous toxicities is directly tied to maintaining treatment adherence. Appropriate prevention + timely response are essential to prevent treatment discontinuation and preserve quality of life.
Hong Kong patients should understand: though common, skin side effects are manageable with proactive measures; they do not have to passively endure them.
Multidisciplinary collaboration (oncology, dermatology, oncology nursing) is a system-level necessity, not an optional add-on (JAAD).
Even when skin reactions occur, patients should be encouraged to continue therapy, as cutaneous side effects may correlate with therapeutic response and thus serve as an indirect efficacy marker (SpringerLink; Gloucestershire Hospitals NHS Trust).

Conclusion

EGFR-targeted therapy undoubtedly provides survival benefits, but management of skin toxicities determines whether patients can strike a balance between treatment completeness and quality of life.
A “prevention-first, timely-response” strategy, tailored to Hong Kong patients, is the most effective, pragmatic, and applicable solution. From day one of treatment, patients must be educated on skincare and prevention, with established reactive pathways, ensuring they can complete their therapy without interruption due to side effects.

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References

Alberta Health Services Guideline Resource Unit. (2020, November). Prevention and Treatment of Acneiform RashOxford Academic+7Alberta Health Services+7Gloucestershire Hospitals NHS Trust+7.
Wainman, H., & Wallace, K. (2022, July). Management of Skin Toxicity Related to Parenteral Anti‑EGFR Treatment. NHS Gloucestershire Hospitals sagepub.com+6Gloucestershire Hospitals NHS Trust+6esmoopen.com+6.
(2024, July). Managing EGFR Inhibitor Induced Rash. NCODA Health Care PDF The ASCO Post+11NCODA+11Biology Insights+11.
Lacouture, M. E. (2013, May 15). Prevention and Treatment of Acneiform Rash Caused by EGFR Inhibitors. The ASCO Post com+3The ASCO Post+3cdn.mdedge.com+3.
(2021, March). Management Strategies for Cutaneous Toxicity From EGFR Inhibitors. Oncology Nursing Society Voice Oncology Nursing Society+1.
(2023). Managing Side Effects From EGFR Inhibitors. CancerConnect CancerConnect.
MIMS Hong Kong. (2020). Dermatologists Crucial to Managing Side Effects of EGFR Inhibitor Treatment for NSCLC. MIMS HK News Update MIMS.
(2025, ~3 weeks ago). Common EGFR Inhibitor Side Effects and How to Manage Them. Biology Insights Biology Insights.
(2017). EGFR Inhibitors and Cutaneous Complications: A Practical Approach. Springer OncologySpringerLink.

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