Tarceva and Prednisone - 1257932

ssflxl
Posts:204

Dear Friends,

I have been getting terrible, painful scalp rash from Tarceva - just 50mg alternating with 37.5mg. I wonder if anyone has tried low dose oral Prednisone to help with this rash before. I have been using Clobetasol cream 2 times/day for my rash, and had tried Minocin in the past without much benefit. I wonder if low dose Prednisone would help. Do you also think another antibiotic would help?

thanks

ssflxl

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Reply # - July 15, 2013, 03:42 PM

catdander
Posts:

I'm so sorry ssflxl, I hope you will get some input that will help. I'll ask Dr. Walko our oncology pharmacist for input.
Have you discussed a lower dose with your onc. Dr. West has described people doing well on dose as low as 25mg/day

Janine

Reply # - July 15, 2013, 04:56 PM

ssflxl
Posts: 204

Janine,

I was on lower dose, down to 25mg, but have mild progression so Onc wants me to take higher dose, but my scalp is painful - with scabs all over. Like I said, I have tried all the different topical stuff, but it doesn't prevent the rash from coming on. the topical helps the rash dry up and scab over sooner. that's why I am interested in something to help prevent the rash

thanks

ssflxl

Reply # - July 15, 2013, 06:22 PM

Dr West
Posts: 4735

I haven't tried oral prednisone, but anecdotally, I've heard that anti-fungal cream on the scalp can help with these lesions in some patients. But prednisone would also be a good option to consider.

-Dr. West

Reply # - July 15, 2013, 07:43 PM

ssflxl
Posts: 204

Dr. West and other doctors,

do you think a low dose Prednisone like 2.5-5mg would decrease the effectiveness of Tarceva? would there be worrisome problem taking the 2 meds? I have tried Sulfacetamide shampoo too but that still doesn't work. Minocin hasn't worked, but I wonder if Septra might work better, although that gives me GI upset.

thanks for any input into this vexing problem. It might seem to be a minor problem, but it's becoming intolerable especially if I have to increase the dose!!!

ssflxl

Reply # - July 15, 2013, 08:00 PM

Dr West
Posts: 4735

I really doubt 5 mg of prednisone would interfere with Tarceva to any meaningful degree, and I think if so many other things haven't worked, it's a fine thing to try, at least using intermittently if it works. The other thing I often do if people have intermittent problems with side effects is to just hold the Tarceva for a few days or a week or more, then restart. It's a temporary fix, but sometimes all you need is a reset, and it can be something that helps make the longitudinal treatment more manageable.

Good luck.

-Dr. West

Reply # - July 16, 2013, 06:00 AM

dr walko
Posts: 102

I completely agree with Dr. West, though wondering what other topicals you may have tried. We often use Selsun Blue shampoo with good results. Are you using any other hair products that may contain alcohol?

Best wishes,
Dr. Walko

Reply # - July 16, 2013, 11:34 AM

ssflxl
Posts: 204

Dr. Walko:

I have tried Selsun Blue shampoo before - no help. I am now using Nioxin shampoo and conditioner. Maybe I will try Nizoral shampoo.

thanks

ssflxl

Reply # - July 16, 2013, 12:09 PM

Jazz
Posts: 279

ssflxl, have you tried the fluocinonide oil/shower cap combo (Rx only) ? It's an oil you massage into your scalp at night and sleep with, wearing a shower cap. In the morning you shampoo it out. It's not fun but if it helps the sores... Also, doxycycline is the oral antibiotic of choice for this issue, usually. I'm allergic so I used 200mg Minocin daily when on afatinib. The other thing I found helpful was Mupirocin ointment (also known as Bactroban?) on the sores.

I found the medicated shampoos too drying, which seemed to aggravate the rash. Moisturizing shampoos worked better for me. Also, there's a soothing spray I used to get at Target called Shea Moisture (brand name) Dandruff & Dry Scalp Elixir w/Plantain extract, tea tree, & willow bark extract. It says it's for dandruff, eczema & psoriasis. If I was having a particularly bad rash day, I'd spray this and it would cool the burn.

Can you get your hands on Dr. LaCouture's book about skin issues? You may actually need to show the book to your onc/dermatologist to inform them of how serious your situation is. (The dermatologist I was referred to had absolutely no idea about EGFR skin side effects, or side effects from cancer tx.)

Good luck and I hope you continue to do well on Tarceva!

Jazz

Reply # - July 16, 2013, 03:29 PM

ssflxl
Posts: 204

thanks Jazz,

I have used the Fluocinonide oil with the cap - I used it daily after showering.
Unfortunately, I can't tolerate Doxy for long - gets GI uset.

thanks for the tips.

ssflxl

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