INDIVIDUAL ARTICLE: A Practical Algorithm for the Prevention and Treatment of Cutaneous Side Effects of Hormonal Cancer Therapy

May 2025 | Volume 24 | Issue 5 | 49631s3 | Copyright © May 2025


Published online April 30, 2025

Ada Girnita MD PhD IFAAD FEADVa, Peter Bjerring MD DMSc FEADVb, Gabriela Llado Grove MD PhDc, Sampsa Kauppi MDd, Anneke Andriessen PhDe, Charles Lynde MD FRCPCf, Maxwell Sauder MD FRCPC DABDg, Andreas Stensvold MD PhDh

aSkin Cancer Center Karolinska University Hospital Stockholm, Sweden
bDepartment of Dermatology, Aalborg University Hospital, Denmark
cDepartment of Dermatology, Copenhagen University Hospital, Denmark
dPrivate Practice, Terveystalo and Epilaser Oy, Finland
eRadboud UMC; Nijmegen and Andriessen Consultants, Malden, The Netherlands
fAmerican Board of Dermatology, Newton, Massachusetts; Royal College of Physicians and Surgeons of Canada, Ottawa ON, Canada; Department of Medicine University of Toronto, Toronto, ON, Canada; Lynderm Research, Markham, ON, Canada
gAmerican Board of Dermatology, Newton, Massachusetts; Royal College of Physicians and Surgeons of Canada, Ottawa ON,
Canada; Department of Medicine University of Toronto; Onco-dermatologist, Princess Margaret Cancer Centre, Toronto, ON, Canada
hØstfold Hospital Trust, Grålum, Norway

Abstract

Introduction: Hormonal therapies, typically used in the treatment of breast and prostate cancer patients, have been associated with numerous skin toxicities that can impact quality of life and interfere with treatment adherence. Appropriate management is necessary to improve the quality of life for cancer patients and survivors who experience hormonal therapy-related dermatologic toxicities. 
Objectives: To develop a practical, physician-developed algorithm for the management of hormonal therapy-related cutaneous adverse events using prescription treatment and non-prescription skincare.
Methods: The Nordic European Cutaneous Oncodermatology Management (NECOM) 6 advisory board integrated evidence from a structured literature search with the panel's expertise and clinical insights to create a practical algorithm for preventing and treating flushing/hot flashes, pruritus/urticaria, rosacea, alopecia, hirsutism, and hyperhidrosis associated with hormonal therapy. 
Results: An algorithm that aims to improve patient comfort during and after treatment, reduce the incidence of hormonal therapy-related cutaneous adverse events, and promote healing of affected skin areas by using prescription medication and skincare. Suggested management recommendations supplement the algorithm.
Conclusions: Preventing and treating common dermatologic toxicities associated with hormonal cancer therapies is an essential component of care to improve patient quality of life, adherence to cancer treatment, and treatment outcomes. The NECOM 6 algorithm provides management strategies for all HCPs who treat oncology patients to prevent and treat common cutaneous adverse events associated with hormonal cancer therapies.

J Drugs Dermatol. 2025;24:5(Suppl 1):s3-10. 

INTRODUCTION

In Nordic European countries, the annual incidence of new cancer cases between 2018 and 2022 was 642.4 per 100,000 in males and 520.3 per 100,000 in females, with a lifetime risk of developing cancer before age 75 estimated at 32.0% for males and 28.6% for females.1 In 2022, the four most commonly diagnosed cancers in Europe were breast, colorectal, lung, and prostate, accounting for almost half of all cancer diagnoses.2 While cancer incidence continues to rise, advancements in cancer treatment have significantly improved survival rates. Age-standardized death rates in Nordic European countries have declined over the past decade, decreasing annually by 1.9% for males and 1.4% for females.1 However, as cancer care evolves, so does the challenge of managing treatment-related toxicities.

Hormonal therapies used in the treatment of breast and prostate cancer patients have been associated with numerous skin toxicities.3-8 Although healthcare providers (HCPs) may consider cutaneous adverse effects (cAEs) of hormonal cancer therapy an inevitable occurrence that does not need to be addressed, these side effects can significantly reduce quality of life (QoL) and may be burdensome enough for some patients to discontinue their cancer treatment or forego them altogether.3,9

Skincare remains an underrecognized and underused modality for mitigating these adverse events. Although cAEs are a common consequence of cancer treatment, most guidelines do not include skincare measures, highlighting the gap in skincare recommendations in the literature. The aim of this algorithm is to improve patient comfort during/after cancer treatment, to reduce the incidence and severity of hormonal therapy-related cutaneous adverse events, and to promote healing of affected skin areas by using prescription medication and skincare.

Project Update
The Nordic European Cutaneous Oncodermatology Management (NECOM) project aims to improve cancer patients' and survivors' QoL by offering tools to support HCPs treating oncology patients in preventing and managing cAEs. This includes a broad range of