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

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Abstract

Purpose

Epidermal growth factor receptor (EGFR) inhibitors are approved for use as targeted chemotherapeutic agents against multiple solid-organ malignancies. The most common side effect associated with EGFR inhibitor therapy is a papulopustular eruption, which can easily be confused with bacterial folliculitis. In this study, we examine the relative timing and location of the EGFR-induced papulopustular eruption compared to the associated bacterial superinfections.

Methods

In this retrospective chart review, patients enrolled in our institution’s IRB-approved prospective registry of cutaneous reactions to chemotherapy were screened for inclusion. All patients who received an EGFR inhibitor and developed either a papulopustular eruption or bacterial superinfection at some point during treatment were included.

Results

Of the 157 patients who met inclusion criteria, 36 (23 %) developed bacterial superinfections at some point during EGFR therapy. Papulopustular eruptions developed in a highly predictable time course, with a mean time to onset of 1.5 weeks and mean duration of 9.4 weeks. Bacterial superinfections occurred at widely variable time points during therapy with a mean time to onset of 27.7 weeks. Papulopustular eruptions much more frequently affected the face (97 %), chest (75 %), and back (61 %), while bacterial superinfections occurred more commonly on the upper extremity (64 %), lower extremity (47 %), and abdomen (39 %).

Conclusions

The EGFR inhibitor-induced papulopustular eruption has a stereotypical time course and occurs in a characteristic distribution affecting the central face, upper chest, and back. Bacterial superinfections more frequently affect the extremities, abdomen, and groin and may occur at any point during EGFR therapy.

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Authors and Affiliations

  1. Division of Dermatology, Washington University School of Medicine, 660 S Euclid, Campus Box 8123, St. Louis, MO, 63110, USA

    Rachel L. Braden & Milan J. Anadkat

Authors
  1. Rachel L. Braden
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  2. Milan J. Anadkat
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Correspondence to Milan J. Anadkat.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study, and additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Braden, R.L., Anadkat, M.J. EGFR inhibitor-induced skin reactions: differentiating acneiform rash from superimposed bacterial infections. Support Care Cancer 24, 3943–3950 (2016). https://doi.org/10.1007/s00520-016-3231-1

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  • DOI: https://doi.org/10.1007/s00520-016-3231-1

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