EPIDERMAL GROWTH FACTOR RECEPTOR INHIBITORS

By Gary M. White, MD

Epidermal Growth Factor Receptor Inhibitor Skin papulopustular skin rash


Epidermal Growth Factor Receptor (EGFR) Inhibitors frequently cause various skin rashes.

Clinical

Common reactions include papulopustular or acneiform rash, pruritus, erythema, fissures, and paronychia. A series of 32 cases of a purpuric eruption mainly affecting the lower legs has been reported [JAMA Derm 2017;153;906]. Annular lesions and non follicular pustules were common. Surprisingly, a LCV was seen histologically in only 9% of patients.

A necrolytic migratory erythema-like rash has been reported with gefitinib [JAMA Derm 2016;152;947].

Treatment

Focusing on panitumumab, Bergman et al have recommended the following [JAAD 2014;71;754]:

A study of erlotinib-treated patients showed that doxycycline 100 mg/day mildly decreased the incidence and severity of folliculitis [JAAD 2016;74;1077]. The combination of clindamycin phosphate and benzoyl peroxide gel (DUAC) once daily for 8 weeks showed benefit [JEADV 2016;30;1436].

There is a report of a man taking cetuximab with a tetracycline-resistant acneiform eruption successfully treated with oral ivermectin (200 ug/kg once and repeated in 10 days) [JAMA Derm 2017;153;939].

For pyogenic granuloma and pseudopyogenic granuloma see here.

Additional Pictures

Epidermal Growth Factor Receptor Inhibitor Skin papulopustular skin rash

Paronychia with pyogenic granuloma.
Epidermal Growth Factor Receptor Inhibitor Associated Paronychia

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