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Extreme Phenotype of Epidermal Growth Factor Receptor Inhibitor-induced Destructive Folliculitis
Florian Anzengruber1, Barbara Meier1, Julia-Tatjana Maul1
1Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
Abstract:
Due to the increasingly widespread use and side effect profile of epidermal growth factor receptor inhibitors (EGFRIs), cutaneous side effects of these drugs are frequently encountered. The EGFR is expressed on keratinocytes and fibroblasts. Inhibition of EGFR can produce a range of cutaneous adverse effects, the most frequent being a characteristic acneiform skin eruption. As the latter is associated with good anti-neoplastic responses, the onset of EGFRI-induced acneiform skin eruption is typically viewed as a positive sign by patients and physicians. It can usually be treated well with standard acne drugs, but in rare cases, the skin eruption can be so severe that systemic therapy and/or interruption of EGFRI treatment are required. One of the severest forms of EGFRI-induced skin eruption occurring on the head and neck area resembles folliculitis decalvans. Here, we discuss the management of such a case seen in our department. In addition, we present an analysis of tumor necrosis factor-α, interleukin-1β (IL-1β), and IL-17A expression based on immunohistochemical stains and qPCR.
Insights
Epidermal growth factor receptor inhibitors (EGFRIs) can cause severe skin eruptions, sometimes resembling folliculitis decalvans. Management involves standard acne treatments, but severe cases may require systemic therapy or drug interruption.
Area of Science:
- Dermatology
- Oncology
- Pharmacology
Background:
- Epidermal growth factor receptor inhibitors (EGFRIs) are widely used cancer therapies.
- Cutaneous side effects are common with EGFRIs, with acneiform eruptions being the most frequent.
- EGFR is crucial for keratinocyte and fibroblast function.
Observation:
- EGFRIs can induce various skin reactions, most commonly an acneiform eruption.
- This eruption is often seen as a positive indicator of treatment efficacy.
- Severe cases, particularly on the head and neck, can mimic folliculitis decalvans.
Findings:
- The study discusses the management of a severe EGFRI-induced skin eruption resembling folliculitis decalvans.
- Analysis of tumor necrosis factor-α, interleukin-1β (IL-1β), and IL-17A expression was performed using immunohistochemical stains and qPCR.
Implications:
- Understanding EGFRI-induced skin toxicities is crucial for patient management.
- Severe cutaneous reactions may necessitate treatment adjustments or interruptions.
- Further research into the inflammatory pathways (TNF-α, IL-1β, IL-17A) may guide therapeutic strategies.
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