Rash (acneiform and maculopapular)
Erythema, oedema, papulopustular eruptions followed by crusting and dryness of the skin.
Characterised by the presence of macules (flat) and papules (elevated). Frequently affects the upper trunk, spreading centripetally and associated with pruritus.
Contributing factors / Causes
- Chemotherapy (e.g. taxanes)
- Biological (targeted) therapies
- Monoclonal antibodies (e.g. Herceptin)
- Shingles (also called herpes zoster)
- Skin metastases
- Medications (e.g. sexamethasone and newly commenced drugs)
- Allergies
Acneiform Rash Grading Scale (adapted NCI CTCAE)
Grade 1 (Mild) |
Grade 2 (Moderate) |
Grade 3 (Severe) |
Grade 4 (Life Threatening) |
Papules and/or pustules covering <10% body surface area (BSA), which may or may not be associated with symptoms of pruritus or tenderness |
Papules and/or pustules covering 10-30% BSA which may or may not be associated with symptoms or tenderness; associated with psychosocial impact; limiting instrumental activities of daily living (ADL) |
Papules and/or pustules covering > 30 BSA, which may or may not be associated with symptoms of pruritus or tenderness; limiting self-care ADL; associated with local superinfection with oral antibiotics indicated |
Papules and/or pustules covering any % BSA, which may or may not be associated with symptoms of pruritus or tenderness and are associated with extensive superinfection with IV antibiotics indicated; life threatening. |
Maculopapular Rash Grading Scale (adapted NCI CTCAE)
Grade 1 (Mild) |
Grade 2 (Moderate) |
Grade 3 (Severe) |
Macules/papules covering <10% BSA with or without symptoms (e.g. pruritus, burning, tightness) |
Macules/papules covering 10-30% BSA with or without symptoms (e.g. pruritus, burning, tightness); limiting instrumental ADL; rash covering > 30 BSA with or without mild symptoms |
Macules/papules covering > 30 BSA with moderate or severe symptoms limiting ADL |
Grade 1 (Mild) – Non Urgent and Grade Moderate |
Patient Management ● Prevention, support, teaching, and follow-up as required ● Assessment - Timing of onset, appearance, distribution (skin changes varies with each type of treatment) - Assess for early signs of acneiform (e.g. redness, papulopustules, tenderness of affected areas, dry, furrowed skin) - Ask patient to take photo (if possible) and attach to nurse summary for clinician/team ● Skin Care and hygiene - Wash and clean skin with lukewarm water; gently pat dry (avoid hot water) - Avoid sun exposure during treatment – use sun block - Avoid popping acne pustules - Avoid topical anti-acne or anti-rosacea agents - Promote adequate hydration/nutrition during treatment to help prevent skin dryness or desquamation ● Pharmacological management - Collaborate with clinician / team - For medical assessment of acneiform rash / maculopapular rash ● Patient education and follow-up - Encourage daily self-assessment of skin - When to seek immediate medical attention: - temperature greater than or equal to 38°C and/or presence of redness, discharge or odour from open areas when unable to perform ADLs when pain is not controlled |
Grade 3 Severe |
● Requires medical attention within 24 hours ● Collaborate with clinician / team ● Arrange for further evaluation and assessment in outpatient / ambulatory setting |
Grade 4 Life Threatening |
Presence of the following: - Temperature greater than or equal to 38°C - Uncontrolled pain Patient Management ● Grade 4 – Emergency ● Requires IMMEDIATE medical attention ● Admission to hospital ● Notify clinician / team of ABC CNS assessment ● Notify Emergency Department ● If patient is on targeted / immunotherapy, this will require delays in treatment until symptoms resolve or Discontinuation of treatment. Refer to local DHB treatment protocols. |
