Topical Management Strategies for Acneiform Eruptions Induced by Cancer Drugs

Acneiform eruptions are common dermatological side effects of cancer therapies, particularly those involving tyrosine kinase inhibitors (TKIs) and epidermal growth factor receptor (EGFR) inhibitors, and can significantly impact patients' quality of life.

The primary objective of this study was to evaluate the effectiveness of various topical therapies for managing cancer drug-induced acneiform eruptions and to assess patient-reported outcomes. Secondary objectives include comparing tolerability profiles and examining associations between malignancy types, treatment regimens, and eruption patterns.

This prospective observational study was conducted from January to December 2023 at the Departments of Dermatology, Abbas Institute of Medical Sciences (AIMS), Muzaffarabad, and Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. A total of 116 patients aged 18 years or older who developed acneiform eruptions following cancer therapy were enrolled. Participants received topical treatments, including corticosteroids, benzoyl peroxide, metronidazole, retinoids, and antibiotics (clindamycin or erythromycin). Clinical assessments included lesion count, severity grading, and patient-reported outcomes (pain, itching, quality of life), recorded at baseline and at 2-, 4-, and 8-week follow-ups. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2018; IBM Corp., Armonk, NY, US). Treatment efficacy comparisons were made using chi-square tests for categorical variables, t-tests for continuous variables, and multiple linear regression to identify independent predictors of lesion reduction.

Antibiotics were the most commonly used treatment (30 patients, 25.86%), followed by benzoyl peroxide (27 patients, 23.28%) and corticosteroids (25 patients, 21.55%). By week 8, 99 patients (85.35%) presented with only mild lesions. Topical antibiotics (clindamycin/erythromycin) demonstrated the highest effectiveness, with a mean lesion count reduction of 7.2 ± 1.8 and severity reduction score of 3.6 ± 1.2, achieving an overall efficacy of 54%. Multiple linear regression analysis identified a later onset of acneiform eruptions (>5 weeks after therapy initiation) as a significant predictor of greater lesion reduction (β = -0.30, p = 0.047). Metronidazole was associated with the lowest incidence of adverse effects (2 patients, 13.33%). Both topical antibiotics and benzoyl peroxide significantly reduced lesion count and severity.

These findings suggest that topical antibiotics, benzoyl peroxide, and corticosteroids are effective in managing cancer therapy-induced acneiform eruptions, with notable improvements in clinical severity and patient-reported outcomes. Additionally, a later onset of eruptions may be associated with a more favorable therapeutic response.