Photosensitive lichenoid skin reaction to capecitabine

BACKGROUND: Capecitabine is an oral prodrug of fluorouracil, which is a common agent used in the management of many solid tumor malignancies. Dermatologic reaction is common with various chemotherapy agents but is not commonly reported in the use of capecitabine. When adverse reactions of rashes occur, the offending agent is typically removed. We report here an unusual case of photosensitive lichenoid rash due to capecitabine which is managed conservatively without major alteration in treatment. CASE PRESENTATION: Seventy-three year old female with a diagnosis of stage IV breast cancer undergoing management with capecitabine presents with a rash during the summer months that is biopsy proven to be lichenoid photosensitive rash with likely offending agent being capecitabine. Her treatment was initially held despite having response to treatment, started on topical steroids after evaluation by dermatology. Given her response to treatment, drug was resumed with instructions to use sun precaution, sunscreen, and to complete course of topical steroids until rash resolution. CONCLUSION: Drug-related rashes tend to lead to disruptions or alterations in treatments of malignancies, despite responses. Given the wide use of capecitabine in many different solid tumors, it is important to recognize this photosensitive related skin rash and to initiate appropriate precautions of sun safety and topical steroids to allow minimal disruptions in therapy and continue use of capecitabine.