Pimecrolimus cream 1% for the treatment of papulopustular eruption related to epidermal growth factor receptor inhibitors: a case series and a literature review of therapeutic approaches.
BACKGROUND
Cutaneous side effects of epidermal growth factor receptor inhibitors (EGFRIs) are very frequent and well known. The aim of our study was to investigate the efficacy and safety of pimecrolimus 1% cream in the treatment of papulopustular eruption caused by EGFRIs and to review the relevant literature on therapeutic approaches.


METHODS
Twenty cancer patients being treated with EGFRIs were included in the study. Nine of the patients showed grade 1 and 11 showed grade 2 papulopustular eruption. All patients were treated with pimecrolimus 1% cream, which was applied twice daily. Patients with grade 2 eruption also received systemic minocycline 100 mg/day.


RESULTS
All patients with grade 1 eruption responded to treatment, with 4/9 experiencing complete resolution of the lesions 2 weeks after the initiation of treatment. Five out of 11 patients with grade 2 eruption had more than 50% improvement in erythema and pustules, and 1 had complete resolution of the skin lesions. Two patients did not respond to treatment but were significantly improved after substitution of pimecrolimus 1% cream with metronidazole 1% cream. No side effects were recorded.


CONCLUSIONS
Our case series shows that pimecrolimus cream may be an effective and safe approach in the management of papulopustular eruption related to EGFRIs.
Nikolaou
V
V
Department of Dermatology, A. Sygros Hospital, Athens, Greece. drviknik @ yahoo.com
Stratigos
A
A
Antoniou
C
C
Kiagia
M
M
Nikolaou
C
C
Katsambas
A
A
Syrigos
K
K
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000627:therapeutic use*; D003875:Drug Eruptions / Q000188:drug therapy* / Q000209:etiology; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D008911:Minocycline / Q000627:therapeutic use; D009369:Neoplasms / Q000188:drug therapy; D009824:Ointments; D011446:Prospective Studies; D047428:Protein Kinase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012393:Rosacea / Q000188:drug therapy* / Q000209:etiology; D016559:Tacrolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D003879:Dermatologic Agents; D009824:Ointments; D047428:Protein Kinase Inhibitors; D008795:Metronidazole; C117268:pimecrolimus; D066246:ErbB Receptors; D008911:Minocycline; D016559:Tacrolimus