TNF and Erythema: Cytokines IL-1β play a role for inflammation and dilation of blood vessels so that it is likely to increase the concentration of chemotherapy in the area, and TNF-α causes tissue damage; (c) The signaling and amplification phase in which TNF-α activates NF-kβ, mitogen activated protein kinase (MAPK), and sphingomyelinase pathways that magnify cell and tissue damage resulting in erythema and epithelial atrophy 4-5 days after the initial stage of chemotherapy.