Pharmacological Innovations in Managing Cancer Therapy Related Skin Toxicities: A Narrative Review for Supportive Oncology

Introduction: Cutaneous toxicities are common and distressing complications of cancer therapy, impairing quality of life (QoL), treatment adherence, and psychological well-being. Despite their high prevalence, management has historically relied on supportive measures with limited efficacy. Recognizing skin health as integral to supportive oncology, this review highlights novel pharmacological strategies that may improve outcomes and reduce treatment interruptions. Areas covered: We conducted a literature search (PubMed, Embase, Cochrane; 2015–2025) to synthesize evidence on skin toxicities across chemotherapy, targeted therapies, immunotherapy, and radiotherapy. We discuss pathophysiological mechanisms underlying these toxicities and emerging pharmacological interventions, including biologics (dupilumab, JAK inhibitors), barrier-repair agents, antioxidants, advanced topical and systemic formulations, and repurposed drugs. Special attention is given to vulnerable populations—patients with darker skin phototypes, those in low- and middle-income countries (LMICs), and pediatric/geriatric oncology patients—where equity gaps in evidence and access are most pressing. Expert opinion: Dermatologic adverse events are no longer secondary concerns; they represent a central component of supportive oncology. Innovative, mechanism-based pharmacological approaches hold promise to transform management, but robust randomized controlled trials remain limited. Future directions include biomarker-driven prevention, integration of digital toxicity monitoring, and global equity–focused guidelines. Prioritizing dermatologic health alongside oncologic efficacy can help preserve treatment intensity, minimize hospitalizations, and enhance patient quality of life worldwide