. 2013 Feb 1;27(9):1071–1080. doi: 10.1111/jdv.12082

Table 1.

List of key references recommending the use of cosmetic agents in combination with chemotherapy

Author	Study design	Title	Comments
Lacouture⁹	Review	Mechanisms of cutaneous toxicity
Segaert S et al.⁷	Review article	Clinical signs, pathophysiology and management skin toxicity	Adequate sun protection
			Avoid skin drying cosmetic products
			An emollient on hands and limbs to prevent fissures
Segaert S et al.⁶	Review article	Skin toxicities of targeted therapy	Maximize skin hydration
			Sun protection
		Rash: Avoid retinoids
			Xerosis: oil-in-water creams, 5-10% urea
			Paronychia: Topical antiseptic
Robert C et al.⁵	Review article	Cutaneous side-effects of kinase inhibitors and blocking antibodies	Camouflage cosmetics for folliculitis
			Xerosis: prescribe 5–10% urea
Ouwerkerk, J et al.³⁰	Review article	Anti EGFR for metastatic colorectal cancer	Sunscreen >15+
			Avoid cleaning detergents
			Mild body cleansers
			Moisturizers
			Avoid alcohol-based products
			Cosmetics to conceal rash
		Gentle non-alcohol-based cleansers
Perez-Soler et al.¹⁴	Guideline	HER1/EGFRI assoc rash: future directions for mgt and outcomes from the HER1/EGFRI rash management forum	Cover rash with make-up
			Use a skin-friendly make-up remover
			Use emollients to prevent skin dryness
			Use a good sunscreen
			Avoid over-the-counter acne medication
Burtness et al.¹	Guideline	Task force report. Management of dermatological and other toxicities associated with EGFRI in patients with cancer.	Initiate treatment early
			Avoid using antiacne medication
			Thick emollients
			Mild soap
Bernier et al.³⁶	Guideline	Consensus guidelines for the mgt of radiation dermatitis and acne-like rash in patients receiving radiotherapy+ EGFRI for the treatment of head and neck squamous cell carcinoma	Use gentle cleansers
			Topical cosmetics for symptomatic relief
			Avoid sun exposure (mineral sunblocks or clothing)
			Avoid perfumes and alcohol-based lotions.
Lynch TJ et al.⁶	Guideline	EGFRI dermatologic toxicity overview of outcomes.	Expert opinion
			Initiation of treatment, moisturize dry areas twice daily
			Thick alcohol-free emollient
			Broad-spectrum sunscreen 15+ or higher
			Add Medical treatment if severity increases.
Infections
Grenader T et al²³	Case report	Staph aureus on culture following erlotinib treatment

Author	Study Design	Population	Intervention	Sample size	Outcome measurement	Results
Fluhr ²¹	3-week, controlled, monocentric, study	Experiencing dry, sensitive skin during chemotherapy	Application of acidic pH 5.5 washing emulsion and body lotion	30	Skin-surface pH	Improved skin physiology
					TEWL	Sig increase in stratum corneum hydration P < 0.001
					Corneometer	Reduced TEWL P > 0.007
					Sebumeter	Significant reduction of skin symptoms P < 0.001
					Clinical evaluation
Roé E et al²⁹	Prospective, uncontrolled study of toxicity	Cetuximab or erlotinib	Severity graded	30	Application of an emollient for treatment of xerosis	Good control of symptoms.	No description of which cosmetic products used when.
					Antiseptic soaps
Pre-emptive skin-care management reduces incidence and severity of skin rash
Wohlrab³⁴	Monocentre POC	Breast cancer chemotherapy	Application of an emollient	13	DLQI – quality-of-life questionnaire	Maintains quality of life and reduces frequency of adverse events	Poster
Ocvirk J et al ²²	Prospective, monocentre, uncontrolled study	cetuximab Review of local practice for management of skin toxicity	Application of an emollient after the first documented cutaneous toxicity	31	Skin toxicity Classification using NCI CTCAE v3.0	29.03% grade 1 – advised emollients	Recommend prompt application of topical emollients. Add topical of systemic medication for increasing severity.
		Xerosis	Grade 1 were treated with emollients			51.61% grade 2 – advised emollients + topical antibiotic
		fissures	Grade 2 emollients+ antibiotics			19.36% grade 3 – interruption of treatment then emollients + topical antibiotics
			Grade 3 emollients+ systemic antibiotics			Xerosis – advised emollients 2–5% urea
						Fissures – creams + dexpanthenol
Use of beauty care and cosmetics improves quality of life and management of side-effects
Boone SL et al¹³	Qualitative Survey	Oncology providers	51 item, open-ended questionnaire pertaining to incidence of rash among patients on EGFRI, treatment practices, patient perceptions, outcome treating rash	110		71–90% of patients experience rash.
						8% of providers surveyed obtained a dermatology consult.
						Grade 3 and 4 rash interfered with EGFRI therapy (3%).
Taggart L et al³⁹	Pilot study	Cancer patients	Participation at a look-good–feel-better workshop	20	Self-image NSC	Improved self-image (P < 0.005)
					Anxiety STAI	Reduced anxiety (P < 0.01)
Haley et al¹⁸	Monocentre, uncontrolled study	Cancer patients receiving either cytotoxic chemotherapy, targeted, or hormonal and/or radiotherapy	Applied three test products after first toxicity visit skin and face moisturizer and face wash	99	Q of L: Skindex questionnaire	Significant decrease (P = 0.0003) from baseline in mean overall skindex score
Merial-Kieny C et al⁵²	Multicentre qualitative survey	Visible cutaneous side-effects following chemotherapy	Participated in a make-up training seminar	90	Self-completed questionnaire on tolerance, quality of life and the make-up techniques	95,4% very or satisfied with tolerance
			Applied a hypoallergenic make-up			81,2% improved their quality of life.
Amiel P et al⁴⁰	Multicentre, qualitative survey	Cancer patients	Survey of patient experience receiving various beauty-care services	60	Observation and semistructured interviews	18/40 appreciated information on treating skin problems
						23/40 appreciated information on make-up techniques
Titeca G et al⁴¹	Prospective, randomized, controlled multicentre study	Breast cancer Antitumor chemotherapy	2H cosmetic care interview	27	VQ dermatological questionnaire	less discouraged (P = 0.032)
						more self-confident (P = 0.032)
Williams S et al⁴⁶	Outpatient chemotherapy clinics	First chemotherapy Breast cancer patients	Informational audiotapes for self care	70	STAI	Treatment group increased use of management techniques
						Symptoms decreased

TEWL, Trans Epidermal Water Loss; NCI-CTC, National Cancer Institute cutaneous toxicity Criteria.