Grade 1:
Asymptomatic or mild symptoms with either redness, dryness or blisters that are not tender/minimally tender.

Grade 1:
Maintain TKI dose. Oral care products can be tried for lesions, blisters and dry mouth Recommend a soft toothbrush.

Grade 1:
Other recommendations: see under advice.

Grade 2:
Moderate pain or lesions/blisters, but can eat and swallow modified diet.

Grade 2:
Maintain TKI dose. See above. Try to use oral care solution, but it may be painful due to the alcohol content.

Grade 2:
If there is no improvement, try lidocaine gel.

Grade 3:
Pronounced pain that affects fluid and food intake.

Grade 3:
1) Pause TKI.
2) Studies with lidocaine gel and oral care products for lesions, blisters and dry mouth
3) If necessary with p.o. analgesics and/or local steroid.
4) Resume TKI at reduced dose when grade ≤ 1.

Grade 3:
If no improvement, the patient must be admitted for IV fluids, and feeding tube should be considered with regard to nutrition.
Consider other differential diagnoses including Steven-Johnson syndrome, Pemfigus etc.

Grade 4:
Serious lesions and/or severe pain requiring acute intervention.

Grade 4:
1) Discontinue TKI.
2) The patient should be admitted for pain management, fluids therapy, and tube feeding.
3) Supervision by dermatologist to exclude other diagnoses (see grade 3).

Grade 4:
In the event of improvement, a second TKI at a reduced dose may be considered. To be discussed with specialist.