Management of EGFR-inhibitor associated rash: a retrospective study in 49 patients

Here, we present a retrospective, uncontrolled, comparative study in 49 patients on three established regimens for the management of EGFRI-associated rashes.Strikingly, patients' rash severity improved significantly over three weeks of treatment with topical mometason furoate cream, topical prednicarbate cream plus nadifloxacin cream, as well as topical prednicarbate cream plus nadifloxacin cream plus systemic isotretinoin.In summary our results demonstrate that EGFRI-associated rashes can be effectively managed by specific dermatologic interventions. Whereas mild to moderate rashes should be treated with basic measures in combination with topical glucocorticosteroids or combined regiments using glucocorticosteroids and antiseptics/antibiotics, more severe or therapy-resistant rashes are likely to respond with the addition of systemic retinoids.In recent years inhibitors directed against the epidermal growth factor receptor (EGFR) have evolved as effective cancer-targeting drugs [1]. These drugs include monoclonal anti-EGFR antibodies, such as cetuximab or panitumumab, as well as small molecule EGFR tyrosine kinase inhibitors, such as erlotinib or gefitinib. Additionally, current studies report promising results on the clinical effectiveness of drugs that target the EGFR-signaling cascade, such as the BRAF inhibitor vemurafenib or MEK inhibitors [2]. Characteristic inflammatory papulopustular exanthemas, often described as acneiform or rosaceaform rashes, are the most frequent adverse effect associated with the use of EGFR-inhibtors (EGFRI) [3-6]. Within the first days to weeks of therapy > 90% of patients develop these rashes. In the majority of cases skin lesions initially appear within areas of skin that bear high densities of seborrheic glands. However, the rash may progress into other areas, generalize in the course, or progress into perifollicular xanthoma [7]. Notably, recent studies have demonstrated that rash appearance and severity are correlated positivel