Managing BCR-ABL Inhibitor Associated Skin Rash

Mario E. Lacouture, MD, a dermatologist at Memorial Sloan-Kettering Cancer Center, describes the management of dermatologic adverse events that occur as a result of treatment with BCR-ABL inhibitors, such as imatinib, dasatinib, nilotinib, and ponatinib.

The BCR-ABL inhibitors are generally well tolerated as a class; however, approximately 60% of patients on imatinib develop a maculopapular rash often associated with pruritus and very dry skin. With the other agents, such as dasatinib, nilotinib, and ponatinib, the rash occurs in only a third of patients.

The rash associated with these BCR-ABL inhibitors is generally very rough and dry in appearance. The treatment for this rough skin, known as keratosis pilaris, is the use of topical moisturizers that contain exfoliants, such as ammonium-lactate or lactic acid, salicylic acid, or urea. However, the use of these treatments may cause burning for any open or erythematous areas. As a result, for patients with these conditions, Lacouture suggests referral to a dermatologist, if one is available.