There is a strong guarantee a rash will result when you are on MEK therapy, and there is a consensus that early and aggressive management of dermatologic toxicity associated with MEK therapy can reduce the severity of the rash.

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Most of the below is based off data I collected from doctors. I’m also including products that I like from years of managing my adult acne. I began Mekinist February 9, 2021 and have been told I won’t see a rash for about 45 days, so as of posting this, I have not tried all the protocol doctors recommend.

Two Weeks Before Starting Mek Therapy I moisturized 2x daily using a thick moisturizer, either Eucerin or Aquaphor. (Read the Eucerin label – some want you to limit sun exposure after using them.)

Yale Pharmacy advised I drink 60-100 fluid ounces of water daily. This seemed reasonable because it will flush out the toxins but also help with rash and acne management. I learned that a lot of acne is caused because skin is trying to make itself moist.
 

On the day I began Mekinist

1. I started an oral steroid regimen with Doxycycline. To minimize ill-effects on my guts, each time I take doxy, I drink 16 oz of water and have a carb. Then, 4-6  hours after my morning doxy, I have a probiotic. Six hours later, I have evening doxy, 16 oz water, and more carbs.

2. 2x daily I moisturized my feet with Okeef Working Hands – I have designated bed socks.

3. 2x daily I moisturize. In the morning I use Cetaphil Cream. Bathing in the evening – using Eucerin or Aquafor. I always let creams sit for 5 min before putting on clothes… often I have to buff off some Aquafor.

4. 2x daily I was my face with a mild cleanser. I particularly like La Roche Posay, but also have had good results with Cetaphil cleanser. (I have not tried it with the rash.)

5. 2x daily I moisturize with Vanicream since it specifically says it’s non-pore clogging.

6. Sunscreen with Zinc. The doxycycline makes you photo-sensitive. I put this anywhere there is exposed skin.

7. A couple times a week at night I apply pure aloe to my face – this is purely from what I’ve learned from estheticians. If my rash reacts badly to it, I will stop.

Bathing
Daily baths (not showers) using mild cleansers and a high‐quality skin moisturizer applied over the entire body twice a day and within 5 minutes after taking a bath. I alternate between Eucerin and Aquafor. (At the start of my Mekinist I have not bathed daily for fear of it drying out my skin. This may become necessary to keep the rash germ-free.)
 

Bleach Baths
3–4 times per week to reduce the risk of infection and ameliorate inflammation and pruritus.
one‐quarter to one‐half cup of bleach is added to a full bathtub, or 1 tsp per gallon, and soak for 5–10 minutes rinse with water and application of an emollient diffusely on the skin.
(While doctors recommend bleach baths, I have a bleach sensitivity and am trying chlorhexidine. I feel safe doing this since it is a recommended treatment for folliculitis and it is used as topical disinfection of wounds and to manage skin infections.)

Hair
Wash and condition with selenium‐based shampoo and conditioner for a dry or itchy scalp.
(I thought I was going to really miss my salon shampoo, but I found that I like Vanicream’s sulfate free, dye free products. My hair is still soft and bouncy.)

For prevention of facial acneiform rash
Pimecrolimus cream and clindamycin lotion can be applied to acne‐prone areas (often the “T” zone) morning and night in post-pubertal patients at initiation of MEK therapy. (I am having luck adding ammonium lactate into my beauty repertoire 3-4x a week)

If a mild acneiform rash comes despite preventive treatment
Topical application of clindamycin 2% lotion and a low‐potency topical steroid such as hydrocortisone 1% lotion can be used twice daily. For moderate to severe acneiform rashes, oral antibiotic treatment is recommended.

(The dermatologist I started seeing recommends the hydrocortisone cream by Vanicream. To reduce itching to certain areas, members of an NF group I belong to swear by Sarna. I do not know how well it works with this kind of rash, but I bought some to have on hand.)

 

For more eczematous rashes that progress
Data I read recommends a mid‐potency topical steroid such as triamcinolone 0.1% ointment applied twice per day until the rash resolves (typically 5–7 days).

 

Eczematous dermatitis
Additional data I read says that this can be treated initially with the topical application of pimecrolimus or low‐potency topical steroid such as hydrocortisone 2.5%.

Folliculitis
Can initially be treated with the application of clindamycin lotion to affected areas and the use of germicidal skin cleanser, such as chlorohexidine, in the bath daily. For moderate to severe folliculitis, oral antibiotic treatment is recommended as described above for acneiform rashes.

 

Mild Paronychia
Gentle nail care with moisturizers and antiseptic soaks with chlorhexidine for 10–15 minutes used 3–4 times per day are recommended.

For moderate paronychia mupirocin, high‐potency topical steroids such as fluocinonide 0.05% ointment can be applied around the inflamed nails twice a day. In these cases, patients should be examined to rule out the presence of a superinfection, which might necessitate oral antibiotics, or an abscess or felon, which may necessitate incision and drainage.

 

WARNINGS FROM EXPERTS

All patients should be advised to practice good sun safety including the use of cover‐ups, such as a wide‐brimmed hat and lightweight clothing that covers the skin. Sunscreen that contains zinc oxide or titanium dioxide should also be applied every 2–3 hours when outdoors and applied to the face daily even when not planning to be outdoors.

 

AVOID
Products with added fragrance such as soaps, laundry detergent, and scented creams

Ultraviolet light, which can trigger acneiform rash and skin inflammation in patients on MEK inhibitors.

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