EGFR inhibitor-induced skin reactions: differentiating acneiform rash from superimposed bacterial infections

Braden, Rachel L.; Anadkat, Milan J.

doi:10.1007/s00520-016-3231-1

Cited by 34 publications

(26 citation statements)

References 27 publications

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“…These suppress inflammatory reactions of the aseptic AfE as well as secondary infection that develops several months later. 16 Increase in TEWL and erythema index on the cheek soon after starting EGFRI in the present study supports the importance of pre-emptive therapy with tetracycline for AfE. Higher levels of SSL and erythema index before therapy were more apparent in NSCLC patients treated with EGFR-TKI than colorectal cancer patients treated with an anti-EGFR antibody drug.…”

Section: Discussionsupporting

confidence: 83%

“…Oral minocycline or doxycycline has been recommended for control of AfE. These suppress inflammatory reactions of the aseptic AfE as well as secondary infection that develops several months later . Increase in TEWL and erythema index on the cheek soon after starting EGFRI in the present study supports the importance of pre‐emptive therapy with tetracycline for AfE.…”

Section: Discussionsupporting

confidence: 75%

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Instrumental evaluation sensitively detects subclinical skin changes by the epidermal growth factor receptor inhibitors and risk factors for severe acneiform eruption

Kikuchi

Nozawa

Yamazaki

et al. 2018

The Journal of Dermatology

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Epidermal growth factor receptor inhibitors (EGFRI), EGFR tyrosine kinase inhibitors (TKI) and anti‐EGFR antibodies commonly develop skin toxicities including acneiform eruption (AfE). However, precise skin changes and risk factors for severe AfE are still unclear. The objective of the current study was elucidation of the useful parameters for early and sensitive detection of the skin changes by EGFRI. Transepidermal water loss (TEWL), skin surface hydration, skin surface lipid levels and erythema/melanin index were serially measured for 2 weeks in 19 EGFR‐TKI afatinib/erlotinib‐treated patients and for 8 weeks in 20 anti‐EGFR antibody cetuximab‐treated patients. The TEWL levels of the cheek in the patients who developed AfE of grade 2 and more (AfE ≥ Gr2) were already elevated at 7 days after the initiation of afatinib/erlotinib therapy compared with those before therapy as well as in patients with grade 1 or less (AfE ≤ Gr1). In patients treated with cetuximab, the skin surface hydration on the cheek in AfE ≥ Gr2 patients significantly decreased compared with that of AfE ≤ Gr1 patients at the 2nd and 6th week. Baseline skin surface lipid levels and erythema index on the cheek of patients with AfE ≥ Gr2 were significantly higher than those with AfE ≤ Gr1. The small sample size of the present study, especially for logistic regression analysis, is a limitation. In conclusion, instrumental evaluation declared rapid inflammatory changes of the skin by EGFRI and elucidated oily skin as a risk for severe AfE.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 75%

Instrumental evaluation sensitively detects subclinical skin changes by the epidermal growth factor receptor inhibitors and risk factors for severe acneiform eruption

Kikuchi

Nozawa

Yamazaki

et al. 2018

The Journal of Dermatology

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“…Further, bacterial superinfections of skin and appendages were reported with typical onset months after initiation of cetuximab, i.e. after a mean of 28.6 weeks with a range of 3-144 weeks [13]. …”

Section: Discussionmentioning

confidence: 99%

Severe Pain Due to Paraspinal Abscess Formation in Two Patients with Squamous-Cell Carcinoma of the Head and Neck after Multimodal Treatment Including Cetuximab

et al. 2018

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Background: Patients with squamous-cell carcinoma of the head and neck (SCCHN) on palliative therapy usually have a bad prognosis and suffer from various symptoms. With increasing use of targeted agents in cancer patients at the end of life, the correct assignment of therapy-related symptoms becomes increasingly difficult as cancer-related symptoms usually increase as well. Case Report: We report on 2 cases of patients with SCCHN who received multimodal treatment including palliative therapy with cetuximab. Both patients developed severe thoracic and cervicothoracic pain following treatment. In both cases, extensive paraspinal abscess formation proved to be the underlying cause. One patient was treated conservatively; the other one had to undergo surgical intervention. Conclusions: Awareness of multifaceted therapy-related complications is mandatory when patients receive multimodal treatment including targeted therapies. Unexplained pain syndromes in this context should raise suspicions concerning possible infectious complications and should lead to early use of magnetic resonance imaging.

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“…It is classically distributed in areas of seborrheic activity such as the chin, face, upper back and chest in a "V-shaped" manner. Distribution that deviates from this pattern may signify bacterial infection [2]. Severity is graded according to US Common Terminology for Adverse Events.…”

Section: What Is the Diagnosis?mentioning

confidence: 99%

A painful rash after chemotherapy

Ching

Lam

2019

European Journal of Internal Medicine

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EGFR inhibitor-induced skin reactions: differentiating acneiform rash from superimposed bacterial infections

Cited by 34 publications

References 27 publications

Instrumental evaluation sensitively detects subclinical skin changes by the epidermal growth factor receptor inhibitors and risk factors for severe acneiform eruption

Instrumental evaluation sensitively detects subclinical skin changes by the epidermal growth factor receptor inhibitors and risk factors for severe acneiform eruption

Severe Pain Due to Paraspinal Abscess Formation in Two Patients with Squamous-Cell Carcinoma of the Head and Neck after Multimodal Treatment Including Cetuximab

A painful rash after chemotherapy

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