Among patients treated with EGFR inhibitors, up to 90% have experienced papulopustular eruptions.19 The rash usually developed in the first 2–4 weeks after initiation of therapy as pruritic and tender erythematous papules and pustules on the scalp, face, neck, chest, and back.20 Interestingly, there is a relationship between the development of the rash and the response to chemotherapy and ultimate survival.21 Pruritus is another common adverse event with EGFRIs, affecting up to 54.9% of patients based on particular EGFRI treatment, and which can have a significant impact on quality of life.22 Alexandrescu et al reported treatment with colloidal oatmeal of 11 patients with a rash induced by cetuximab, erlotinib, panitumumab, and sorafenib. Colloidal oatmeal was applied three times a day for 7 days. The overall response rate was 100%, with a complete response of 60%. The authors argue that the observed eruptions in these patients may represent an inflammatory reaction to EGFR inhibitors, thus explaining the response to colloidal oatmeal given its anti-inflammatory properties.23 An additional study in Taiwan studied the benefit of colloidal oatmeal in a sample of 30 patients with dermatologic toxicities associated with EGFR inhibition. Patients applied colloidal oatmeal three to five times a day for 4 consecutive weeks. Dermatologic toxicity severity, body surface area involvement, and pruritus all improved at 4 weeks with no adverse events reported.24 Unlike more potent topical treatments such as topical steroids, metronidazole, erythromycin, salicylic acid, and benzoyl peroxide, colloidal oatmeal is not associated with any toxicity.23
Radiation therapy is used in the treatment of various forms of cancer and is associated with acute and chronic skin changes. Early skin reactions usually occur within days to weeks, initially manifesting as transient to generalized erythema. If the cumulative radiation dose reaches 20 gray, dry desquamation can develop characterized by pruritus, scaling, and flaking of the skin.25 Colloidal oatmeal has been studied as a treatment for radiation-induced skin reactions. In a study of 24 patients undergoing radical radiotherapy for anal cancer, patients were randomized to treatment with either colloidal oatmeal or aqueous cream. Skin reactions for both cohorts were comparable, but the colloidal oatmeal cohort had an appreciable response with regards to epidermal regeneration at follow up.26 As treatments for cancer continue to evolve, so must treatments for their cutaneous adverse effects. Colloidal oatmeal has shown promise with an excellent safety profile.
Radiation therapy is used in the treatment of various forms of cancer and is associated with acute and chronic skin changes. Early skin reactions usually occur within days to weeks, initially manifesting as transient to generalized erythema. If the cumulative radiation dose reaches 20 gray, dry desquamation can develop characterized by pruritus, scaling, and flaking of the skin.25 Colloidal oatmeal has been studied as a treatment for radiation-induced skin reactions. In a study of 24 patients undergoing radical radiotherapy for anal cancer, patients were randomized to treatment with either colloidal oatmeal or aqueous cream. Skin reactions for both cohorts were comparable, but the colloidal oatmeal cohort had an appreciable response with regards to epidermal regeneration at follow up.26 As treatments for cancer continue to evolve, so must treatments for their cutaneous adverse effects. Colloidal oatmeal has shown promise with an excellent safety profile.
CONCLUSIONS
In Part II of this two-part series, we examined the diverse
range of clinical applications of colloidal oatmeal. Colloidal
oatmeal has been shown to be beneficial in the treatment of
atopic dermatitis in African American patients. It also has been
shown to be of benefit in the treatment of hand dermatitis,
xerosis, psoriasis, skin manifestations of diabetes, and in the
treatment of cutaneous adverse effects associated with oncologic therapies. This wide-ranging efficacy and use is backed
by proven safety and tolerability, making colloidal oatmeal an
ideal treatment option in many case scenarios.
REFERENCES
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2. Gunathilake R, Schurer NY, Shoo BA et al. pH-regulated mechanisms account for pigment-type differences in epidermal barrier function. J Invest Dermatol. 2009; 129(7):1719-1729.
3. Nunez C et al. A colloidal oatmeal OTC cream is as clinically effective as a prescription barrier repair cream for the management of mild to moderate atopic dermatitis in African American children. J Am Acad Dermatol. 2013;60(4):AB73. P6654.
4. Sobhan M et al. The efficacy of colloidal oatmeal cream 1% as add-on therapy in the management of chronic irritant hand eczema: A double-blind study. Clin Cosmet Investig Dermatol. 2020;13:241-251.
5. Nebus J, et al. Comparing the effectiveness of an oatmeal cream versus a prescription device cream in improving skin moisturization and barrier function in moderate to severe dry skin. J Am Acad Dermatol. 2011;64(2):S1, AB71.
6. Nebus J, et al. A 3-week moisturization study followed by a 2-week regression phase to evaluate the efficacy of a triple oat skin protectant cream versus a ceramide cream on moderate to severe dry skin. J Am Acad Dermatol. 2014;70(5):S1, AB61.
7. Kalaaji AN, et al. A randomized controlled clinical study to evaluate the effectiveness of an active moisturizing lotion with colloidal oatmeal skin protectant versus its vehicle for the relief of xerosis. J Am Acad Dermatol. 2015;72(5):S1,AB36.
8. Nebus J, et al. The rapid and lasting efficacy of an oatmeal lotion in improving the moisturization and skin barrier properties of extra dry, itchy skin. J Am Acad Dermatol. 2010;62(3):S1,AB56.
9. Nestle FO, et al. Psoriasis. N Eng J Med. 2009;361:496-509.
10. Nollent V, et al. Tolerance and Subject Satisfaction of an Over the Counter Colloidal Oatmeal (Avena Sativa) Lotion in Patients with Psoriasis and Sensitive Skin. Poster accepted for presentation. AAD Annual Meeting 2020.
11. Safa G, et al. Successful treatment of molluscum contagiosum with a zinc oxide cream containing colloidal oatmeal extracts. Indian J Dermatol. 2010;55(3):295-296.
12. Pazyar N, et al. Oatmeal in dermatology: A brief review. Indian J Dermatol Venerol Leprol. 2012;78(2):142-5.
13. Criquet M, et al. Safety and efficacy of personal care products containing colloidal oatmeal. Clin Cosmet Investig Dermatol. 2012;5:183-193.
14. Pierard GE, et al. Critical assessment of diabetic xerosis. Expert Opin Med Diagn. 2013;7(2):201-207.
15. Nebus J, et al. Safety and tolerance of skin protectant lotions with oatmeal in patients with diabetes. AAD Annual Meeting. 2008. AB P932.
16. Kao S, Friedman A. Supportive Oncodermatology: Addressing dermatologic adverse effects associated with oncologic therapies. Oncology Issues. 2018;33(6):64-75.
17. Balagula Y, Rosen ST, Lacouture ME. The emergency of supportive oncodermatology: the study of dermatologic adverse events to cancer therapies. J Am Acad Dermatol. 2011;65:624-635.
18. Osio A, Mateus C, Soria JC et al. Cutaneous side-effects in patients on long-term treatment with epidermal growth factor receptor inhibitors. Br J Dermatol. 2009; 161:515-21.
19. Perez-Soler R, Delord JP, Halpern A et al. HER1/EGFR inhibitor-associated rash: future directions for management and investigation outcomes from the HER1/EGFR inhibitor rash management forum. Oncologist. 2005;10(5):345-356.
20. Lacouture ME, Anadkat MJ, Bensadoun RJ et al. Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities. Support Care Cancer. 2011;19:1079-1095.
21. Saltz LB, Meropol NJ, Loehrer PJ et al. Phase II trial of cetuximab in patients with refractory colorectal cancer that expressed the epidermal growth factor response. J Clin Oncol. 2004;22:1201-1208.
2. Gunathilake R, Schurer NY, Shoo BA et al. pH-regulated mechanisms account for pigment-type differences in epidermal barrier function. J Invest Dermatol. 2009; 129(7):1719-1729.
3. Nunez C et al. A colloidal oatmeal OTC cream is as clinically effective as a prescription barrier repair cream for the management of mild to moderate atopic dermatitis in African American children. J Am Acad Dermatol. 2013;60(4):AB73. P6654.
4. Sobhan M et al. The efficacy of colloidal oatmeal cream 1% as add-on therapy in the management of chronic irritant hand eczema: A double-blind study. Clin Cosmet Investig Dermatol. 2020;13:241-251.
5. Nebus J, et al. Comparing the effectiveness of an oatmeal cream versus a prescription device cream in improving skin moisturization and barrier function in moderate to severe dry skin. J Am Acad Dermatol. 2011;64(2):S1, AB71.
6. Nebus J, et al. A 3-week moisturization study followed by a 2-week regression phase to evaluate the efficacy of a triple oat skin protectant cream versus a ceramide cream on moderate to severe dry skin. J Am Acad Dermatol. 2014;70(5):S1, AB61.
7. Kalaaji AN, et al. A randomized controlled clinical study to evaluate the effectiveness of an active moisturizing lotion with colloidal oatmeal skin protectant versus its vehicle for the relief of xerosis. J Am Acad Dermatol. 2015;72(5):S1,AB36.
8. Nebus J, et al. The rapid and lasting efficacy of an oatmeal lotion in improving the moisturization and skin barrier properties of extra dry, itchy skin. J Am Acad Dermatol. 2010;62(3):S1,AB56.
9. Nestle FO, et al. Psoriasis. N Eng J Med. 2009;361:496-509.
10. Nollent V, et al. Tolerance and Subject Satisfaction of an Over the Counter Colloidal Oatmeal (Avena Sativa) Lotion in Patients with Psoriasis and Sensitive Skin. Poster accepted for presentation. AAD Annual Meeting 2020.
11. Safa G, et al. Successful treatment of molluscum contagiosum with a zinc oxide cream containing colloidal oatmeal extracts. Indian J Dermatol. 2010;55(3):295-296.
12. Pazyar N, et al. Oatmeal in dermatology: A brief review. Indian J Dermatol Venerol Leprol. 2012;78(2):142-5.
13. Criquet M, et al. Safety and efficacy of personal care products containing colloidal oatmeal. Clin Cosmet Investig Dermatol. 2012;5:183-193.
14. Pierard GE, et al. Critical assessment of diabetic xerosis. Expert Opin Med Diagn. 2013;7(2):201-207.
15. Nebus J, et al. Safety and tolerance of skin protectant lotions with oatmeal in patients with diabetes. AAD Annual Meeting. 2008. AB P932.
16. Kao S, Friedman A. Supportive Oncodermatology: Addressing dermatologic adverse effects associated with oncologic therapies. Oncology Issues. 2018;33(6):64-75.
17. Balagula Y, Rosen ST, Lacouture ME. The emergency of supportive oncodermatology: the study of dermatologic adverse events to cancer therapies. J Am Acad Dermatol. 2011;65:624-635.
18. Osio A, Mateus C, Soria JC et al. Cutaneous side-effects in patients on long-term treatment with epidermal growth factor receptor inhibitors. Br J Dermatol. 2009; 161:515-21.
19. Perez-Soler R, Delord JP, Halpern A et al. HER1/EGFR inhibitor-associated rash: future directions for management and investigation outcomes from the HER1/EGFR inhibitor rash management forum. Oncologist. 2005;10(5):345-356.
20. Lacouture ME, Anadkat MJ, Bensadoun RJ et al. Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities. Support Care Cancer. 2011;19:1079-1095.
21. Saltz LB, Meropol NJ, Loehrer PJ et al. Phase II trial of cetuximab in patients with refractory colorectal cancer that expressed the epidermal growth factor response. J Clin Oncol. 2004;22:1201-1208.
