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Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, ChinaDepartment of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong, China
A 76-year-old man presented with a painful rash one week after receiving chemotherapy consisting of cetuximab, oxaliplatin and fluorouracil for metastatic colon cancer. Physical exam was notable for pustules on his neck, chin and upper chest (Fig. 1). He was afebrile.
EGFR inhibitors are used in treatment of colorectal, breast and lung cancers. Apart from tumors, EGFR is expressed in normal tissues including the skin. Its inhibition disrupts skin homeostasis and induces inflammation that commonly manifests as acneiform papules, pustules or folliculitis. The onset is typically one to two weeks after treatment, peaks in 4 weeks, and fades over months with residual hyperpigmentation [
]. 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 [
]. Severity is graded according to US Common Terminology for Adverse Events. Mild to moderate cases usually respond to topical corticosteroids and tetracyclines. Systemic steroids and discontinuation of EGFR inhibitor may be required in severe cases. Notably, acneiform reaction is dose dependent, and may be related to treatment response [
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