Acne-like rash around nose and nosebleeds on Tykerb

[Sandy in Silicon Valley]

Hi,

I've been on Tykerb for 4 months straight now, and have had some bad itching, but the acne-like rash on my face has been mild.

Just recently, pimply rash spots have sprung up just under my nostrils, and even immediately inside my nose. These are very annoying, a bit painful, and tend to pop and bleed when I blow my nose, so they aren't healing as well as spots have on my chin and elsewhere on my face.

Has anyone found a remedy that works well for the Tykerb rash, especially in and around the nose? Anyone else experiencing nosebleeds on Tykerb?

I've been using Regenecare, a wound gel containing lidocaine, collagen and aloe, but it doesn't seem to work well inside and just under my nose - maybe it gets rubbed off too quickly when I use tissues (I have seasonal nasal allergies).

It's certainly not a deal-breaker for the treatment, but I'm taking it along with Herceptin, without any chemo, for now, and we're not even sure it's doing any good...

(((hugs)))
Sandy in Silicon Valley

[hutchibk]

I don't get outright nosebleeds, but I do have raw nasal tissue inside my nose that will give me a blush on tissue when I blow my nose. I use antibiotic ointment inside my nose when it is at it's worst.

Consider if any of these rash fixes might help:

RASH
As far as rash, here are some of the fixes that can be tried by your doctor...

*Employ a proactive approach in managing skin reactions.
*Suggest that patients use a thick, alcohol-free emollient cream.
*Suggest that patients use a sunscreen of SPF 25 or higher, preferably
containing zinc oxide or titanium dioxide
* If patient presents with rash, verify appropriate administration of drug and proceed with the following therapy algorithm:

Mild Rash:
Minimally located
No impact on activities of daily life (ADL)
No sign of superinfection

(shows picture of mild rash occurrence across bridge of nose and cheeks)

Continue EGFR targeted treatment @current dose and monitor for change in severity.

***Use:
Topical hydrocortisone 1% or 2.5% cream and/or Clindamycin 1% gel

Reassess after 2 weeks, if reaction worsens or does not improve, proceed to next step.
_____________

Moderate Rash:
Generalized
Mild Symptoms (e.g. pruritus, tenderness)
Minimal impact on ADL
No sign of superinfection

(shows picture of red worsened rash occurrence (pruritus) across nose, around nostrils, top lip, lower cheeks, and entire chin.)

Continue EGFR targeted treatment @current dose and monitor for change in severity. Continue treatment of the skin reaction with the following:

***Use:
Hydrocortisone 2.5% cream or Clindamycin 1% gel
or Pimecrolimus 1% cream
Plus Doxycycline 100mg BID or Monocycline 100mg BID

Reassess after 2 weeks, if reaction worsens or does not improve, proceed to next step.
________________

Severe Rash:
Generalized
Severe symptoms (e.g. pruritus, tenderness)
Significant impact on ADL
Potential sign of superinfection

(shows picture of worsened rash occurrence similar to moderate with more facial coverage and continuation to shoulders and neck)

Reduce EGFR targeted therapy as per label and monitor for change in severity. Continue treatment of skin reaction with the following:

***Use:
Hydrocortisone 2.5% cream or Clindamycin 1% gel
or Pimecrolimus 1% cream
Plus Doxycycline 100mg BID or Monocycline 100mg BID
Plus Medrol dose pack

Reassess after 2 weeks, if reaction worsens, dose interruption or discontinuation may be necessary.