Drug-induced cutaneous toxicities in solid tumor oncology: mechanisms, manifestations, and management

Cutaneous toxicity is one of the most frequent and visible complications of modern cancer therapy and a major determinant of quality of life, adherence and dose intensity. This narrative review summarizes current knowledge on the mechanisms, clinical patterns and management of dermatologic adverse events caused by anticancer agents used in solid tumors. We integrate data on epidermal growth factor receptor inhibitors, phosphoinositide-3-kinase inhibitors, taxanes such as docetaxel, fluoropyrimidines such as capecitabine, immune checkpoint inhibitors, BRAF and MEK inhibitors, mechanistic target of rapamycin inhibitors, Bruton tyrosine kinase inhibitors and chimeric antigen receptor T-cell therapy. Across these drug classes, skin toxicity reflects on-target disruption of epidermal homeostasis, paradoxical activation of oncogenic pathways in keratinocytes and immune-mediated inflammation or cytokine-driven endothelial injury. Clinically, patients develop papulopustular and maculopapular eruptions, xerosis, pruritus, hand-foot syndrome, mucositis, nail changes, vitiligo-like and psoriasiform reactions, as well as proliferative lesions, including secondary cutaneous squamous cell carcinoma, and in rare cases severe bullous and vasculopathic eruptions. We highlight the vulnerability of older adults, in whom age-related skin changes, comorbidities and polypharmacy amplify the impact of these events while evidence from dedicated prospective studies remains scarce. The review synthesizes practical, mechanism-oriented strategies for prevention and stepwise management, from basic skin care and photoprotection to targeted use of antibiotics, corticosteroids and treatment modification, with the goal of supporting timely recognition of cutaneous toxicity and multidisciplinary care that preserves both quality of life and the anticancer efficacy of therapy.