EGFR-TKI plays a very important role in tumor treatment, but the application of these drugs is commonly associated with various degrees of skin adverse reactions, which in turn interfere with normal treatment and affect patients’ quality of life. Therefore, it is important to control skin adverse reactions effectively without changing EGFR-TKI therapy. The mechanism of EGFR-TKI-related skin adverse reactions is generally considered to be the key cause of EGFR-TKI-related skin adverse reactions due to interference with the epidermal growth signaling pathway in skin follicles and interfollicular cells. The reason. EGFR-TKI inhibits several important roles of EGFR in the epidermis: stimulation of epidermal cell growth, differentiation, protection of cells against UV damage, inhibition of inflammation and acceleration of wound healing, and also affects the proliferation, differentiation, migration and adhesion of keratinized cells. In the table below, EGFR-TKI-related skin adverse reactions are graded according to the following criteria for severity – NCI-CTCAE Criteria (Version 3, 0) Management of rash Mild rash is usually limited in location, has few subjective symptoms, and has no effect on activities of daily living (ADLs) and no signs of dual infection Intervention Continue treatment with the current dose of EGFRI and closely monitor changes in the severity of the rash No treatment required Or topical application of 1% hydrocortisone ointment or clindamycin (10%), erythromycin ointment, and for dry semi-pruritic skin, thin phenol glycerin lotion Bid or benadryl ointment for pruritic localized moderate rash Usually more widespread in extent, but with less subjective symptoms (e.g., pruritus, tenderness, etc.) and no impact on daily life (ADL). Continue treatment with current dose of EGFRI and closely monitor changes in severity of rash Topical application of topical 2 or 5% hydrocortisone ointment or erythromycin ointment, and oral capretin, with oral memantine (doxycycline) as soon as possible if symptomatic. Continue treatment with the current dose of EGFRI and closely monitor changes in the severity of the rash with topical 2 or 5% hydrocortisone ointment or erythromycin ointment and either oral Coretan and memantin (doxycycline) or a shock dose of methylprednisolone if co-infected. Should EGFR-TKI be reduced or stopped for patients with moderate to severe rash? Expert advice: a. EGFR-TKI dose reduction or discontinuation should be used as a last resort after failure of treatment for Grade III skin reactions, and treatment should be interrupted only if the skin reaction persists for 2-4 weeks. b. Treatment of the rash should not be stopped during EGFR-TKI discontinuation because it may last for a long time. c. Some patients should only be temporarily discontinued, and the drug can be continued after the rash improves. Prevention and education Reasonable preventive measures are important steps to control EGFR-TKI skin adverse reactions: C Advise patients to avoid light, targeted drugs mostly have photosensitivity reactions, especially small molecule inhibitors daily to keep the body clean and dry parts of the skin moist. Do not touch alkaline and irritating toiletries, apply mild moisturizer after bathing recommend using broad-spectrum sunscreen with SPF>15 C If the patient develops a rash, it is treated according to the following consensus? Patients with toenail impingement (reverse stripping) may experience nail fungus and local hyperplastic reactions during drug administration? Change foot stress habits and wear loose, breathable shoes during EGFR-TKI treatment? Hot warm water foot soak (continued during medication) or edible salt + water + sliced white radish (or pepper) (boiled) one week before EGFR-TKI treatment Application of skin care products or silicone cream after foot soak can prevent the occurrence of foot rash? Is there a correlation between the rash and survival for the last question of active treatment of tinea pedis? Firstly, the severity of the rash is positively correlated with the efficacy of the treatment Secondly, patients with a rash have a significantly better survival than those without a rash In the case of erlotinib, for example, the BR, 21 and TRUST trials have confirmed that the rash caused by erlotinib treatment can be used as a signal of clinical benefit for patients.