Side Effect: Skin Ulcer

A skin ulcer is a type of wound that occurs when skin breaks down and the underlying tissue is exposed.

Skin ulcers are typically slow to heal and can become a chronic problem if left untreated.

• The appearance of skin ulcers can vary depending upon the underlying cause.
• Most ulcers typically have an open sore or wound that may be shallow or deep.
• The skin around the ulcer may be red, swollen, discolored, painful or warm to the touch.
• In some cases, the ulcer may have drainage or pus coming from the wound.

Skin ulcers can occur for many reasons and can develop on different parts of the body. Some causes of skin ulcers include:

• Prolonged pressure to an area of skin, also called pressure or decubitus ulcers
• Trauma to the skin
• Poor blood flow to an area of skin
• Poor wound healing
• Infection
• Nutritional deficiencies

In patients receiving radiation therapy for cancer treatment, skin damage can occur which can sometimes lead to the development of skin ulcers.

Additionally, skin cancers such as melanoma or basal cell carcinoma can also become ulcerated.

Certain chemotherapy agents can also increase the risk of developing skin ulcers or make it difficult for wounds to heal. These medications include:

• Epidermal growth factor receptor (EGFR) inhibitors:
  • cetuximab (Erbitux©)
  • panitumumab (Vectibix©)
• Vascular endothelial growth factor (VEGF) inhibitors:
  • bevacizumab (Avastin©)
  • sunitinib (Sutent©)
  • sorafenib (Nexavar©)

Ways to prevent skin ulcers can include:

• Avoid activities that may cause pressure or friction to the skin
• Optimize nutrition
• Manage underlying comorbidities that increase your risk of developing ulcers
• Keep skin clean and dry
• Avoid scented soaps and other scented products as these can be irritating to the skin

• Treatment of skin ulcers depends on the underlying cause and severity of the ulcer.
• Treatment may include removing damaged tissue (debridement), surgical intervention or skin grafting.
• Topical treatments may be used to promote wound healing and to keep the area clean.
• If an ulcer is infected, antimicrobial therapy may be used to treat the infection.
• In patient receiving VEGF or EGFR inhibitors for cancer treatment who develop skin ulcers, chemotherapy may be held until the wound heals.