Skin Rash During Melanoma Treatment: How Common It Is and How To Manage It

Skin rash is quite common with several melanoma treatments, including targeted therapies (BRAF and MEK inhibitors) and immune checkpoint inhibitors (such as ipilimumab and nivolumab). ^[1] Many people experience red, bumpy, dry, or itchy skin, and some develop photosensitivity (sunburn‑like reactions) with certain drugs. ^[2] Photosensitivity and maculopapular rash are repeatedly reported with BRAF/MEK regimens like vemurafenib and cobimetinib. ^[3] With ipilimumab plus nivolumab, rashes range from mild redness and bumps to peeling or blisters. ^[4]

How Common Are Rashes?

• Targeted therapy (BRAF/MEK): Maculopapular rash, acneiform eruptions, Grover’s disease, pruritus, and hyperkeratosis are part of a broad spectrum of skin toxicities. ^[5] Reported rash rates vary by drug and combination; maculopapular rash is among the most frequent reactions with these agents. ^[1] Rash onset can be early, often within the first few cycles, and some skin events may persist or appear later during ongoing treatment. ^[6]
• Immune checkpoint inhibitors: Red or bumpy rashes, dry/itchy skin, and sometimes peeling or blisters can occur; prior radiation areas may be more affected. ^[2] Clear skin care guidance is routinely provided because these rashes are expected side effects. ^[4]

Typical Rash Patterns by Therapy

• BRAF inhibitors (vemurafenib, dabrafenib, encorafenib): Maculopapular rash, photosensitivity, pruritus, hyperkeratosis; secondary cutaneous malignancies can also occur, so any new or changing lesion should be assessed. ^[5] Combining with a MEK inhibitor often changes the profile and timing of rashes, with early-cycle onset noted for some regimens. ^[6]
• MEK inhibitors (trametinib, cobimetinib, binimetinib): Acneiform rash is more characteristic, particularly when used with BRAF inhibitors, and often responds to topical antibiotics like clindamycin. ^[7] Acneiform rash in combinations is usually transient and may not require dose changes. ^[8]
• Immune checkpoint inhibitors (ipilimumab + nivolumab): Red, bumpy, itchy rashes are common; blistering or peeling can occur and warrants prompt attention. ^[4]

First-Line Self-Care

• Gentle moisturizers: Use non‑perfumed creams (e.g., sorbolene or aqueous cream) to soothe dryness and itch. ^[2] Regular moisturizing supports the skin barrier and reduces discomfort. ^[4]
• Sun protection: Wear sun‑protective clothing, wide‑brimmed hats, sunglasses, and high‑SPF sunscreen (SPF 50+), especially with photosensitive drugs like vemurafenib. ^[9] Avoid direct sunlight when possible to prevent exaggerated sunburn‑like reactions. ^[9]
• Avoid irritation: Do not scratch; choose loose, soft clothing to reduce friction on inflamed skin. ^[2] Tight clothing can worsen rash symptoms and discomfort. ^[4]

When to Contact Your Care Team

• New or worsening rash, severe itch, pain, blisters, or peeling skin should be reported promptly; specialized supportive dermatology services are available to help manage treatment‑related skin problems. ^[10] Your team may pause or adjust therapy if skin reactions are severe, and will guide creams, dressings, or medicines as needed. ^[11]

Medical Treatments Commonly Used

• Topical therapy: Mild rashes from targeted or immune therapies often improve with topical corticosteroids (to calm inflammation) and emollients; acneiform rashes may respond to topical antibiotics such as clindamycin 1%. ^[8] Acneiform eruptions with MEK combinations are frequently short‑lived and manageable without dose changes. ^[8]
• Oral antihistamines: Helpful for itch associated with maculopapular rashes and pruritus; they can be used alongside moisturizers and sun protection. ^[1]
• Systemic steroids: For moderate to severe immune‑related rashes (e.g., extensive redness, blistering, significant discomfort), clinicians may prescribe oral steroids and adjust immunotherapy based on severity. ^[4]
• Therapy adjustment: In more significant skin events with targeted agents, dose modification or temporary interruption may be considered; dermatology review is recommended when toxicities persist or escalate. ^[12]

Photosensitivity Precautions

Some targeted drugs can cause marked sun sensitivity, leading to sunburn‑like rashes after brief sun exposure; strict sun avoidance and high‑SPF sunscreen are essential. ^[9] Sun protection should be practiced daily throughout treatment, including cloudy days and reflective environments (water, snow, sand). ^[9]

Monitoring Over Time

Skin reactions can appear within weeks of starting therapy and may evolve during treatment; periodic checks for new lesions or changes are important, especially where targeted agents carry risks for keratinocytic growths. ^[6] Ongoing vigilance helps catch issues early and allows timely, conservative management before rashes become severe. ^[5]

Practical Tips You Can Start Today

• Moisturize twice daily with fragrance‑free creams to reduce dryness and itch. ^[2]
• Use SPF 50+ sunscreen, reapplying every 2 hours outdoors; wear protective clothing and avoid peak sun hours if you are on photosensitizing therapy. ^[9]
• Avoid hot showers and harsh soaps; choose gentle cleansers and lukewarm water to minimize irritation. ^[2]
• Report any blistering, peeling, or rapidly spreading rash to your team right away for tailored treatment. ^[4]
• If acne‑like bumps develop, ask about topical clindamycin or similar options, which often help and may avoid dose changes. ^[8]

Key Takeaway

Skin rashes are common and expected with many melanoma treatments, especially targeted BRAF/MEK combinations and immune checkpoint inhibitors, but they are usually manageable with moisturizers, sun protection, topical agents, antihistamines, and, when needed, medical prescriptions or treatment adjustments. ^[1] Early reporting and simple daily care make a big difference in comfort and safety. ^[4]