title: Papulopustular drug eruption due to an epidermal growth factor receptor inhibitors, erlotinib and cetuximab.
abstract: Two patients receiving epidermal growth factor receptor inhibitors for cancer treatment developed papulopustular eruptions a few days after starting treatment. One patient is a 56-year-old man with metastatic lung cancer treated with erlotinib. Bacterial cultures of the nares and a pustule showed no growth. The eruption improved with a lowered dose of erlotinib and the application of topical clindamycin solution and triamcinolone cream. The other patient is a 53-year-old man with metastatic rectal cancer treated with cetuximab. Bacterial culture of a pustule grew Staphylococcus aureus, and a skin biopsy specimen showed a suppurative folliculitis. The eruption improved with a two-week course of oral antibiotics and the application of topical clindamycin solution and triamcinolone cream. A papulopustular eruption occurs in up to 90% of patients treated with epidermal growth factor receptor blocking agents and may correlate with a positive response to chemotherapy. Treatment options are based on anecdotal evidence and may include topical antibiotics, topical glucocorticoids, and oral antibiotics for secondary infection.
authors.affiliation: New York University Department of Dermatology, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bragg
authors.forename: Miriam Keltz
authors.initials: MK
authors.lastname: Pomeranz
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000556:secondary; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000068818:Cetuximab; D003875:Drug Eruptions / Q000097:blood / Q000209:etiology* / Q000473:pathology; D066246:ErbB Receptors / Q000037:antagonists & inhibitors* / Q000097:blood; D000069347:Erlotinib Hydrochloride; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000556:secondary; D008297:Male; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011799:Quinazolines / Q000009:adverse effects* / Q000627:therapeutic use; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000473:pathology; D012393:Rosacea / Q000097:blood / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors; D000068818:Cetuximab