title: Erosive pustular dermatosis of the scalp-like eruption due to gefitinib: case report and review of the literature of alopecia associated with EGFR inhibitors.
abstract: A 69-year-old Japanese woman with multiple brain metastases secondary to non-small-cell lung cancer was treated with radiosurgery, and subsequently started oral gefitinib. Three years later, she presented with erythematous erosive alopecia with pustules on the scalp. A biopsy specimen showed a dense perifollicular infiltration composed of lymphocytes, neutrophils and abundant plasma cells. Methicillin-resistant Staphylococcus aureus was cultured from the lesions; however, treatment with antibiotics was not effective. We diagnosed an eruption resembling erosive pustular dermatosis of the scalp. Although oral steroids did not improve the lesions, the pustules and erythema of the scalp rapidly improved within a few weeks after discontinuation of gefitinib. There have been only 11 case reports of alopecia associated with epidermal growth factor receptor (EGFR) inhibitors including our case. It is noteworthy that all cases were female, and most cases involved the parietal scalp. Moreover, the reduction or discontinuation of the EGFR inhibitors was needed in all cases with erythematous alopecia, which remained as scarring alopecia.
authors.affiliation: Department of Dermatology, Shiga University of Medical Science, Otsu, Japan.
authors.forename: Nagomi
authors.initials: N
authors.lastname: Toda
authors.forename: Noriki
authors.initials: N
authors.lastname: Fujimoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kato
authors.forename: Norikazu
authors.initials: N
authors.lastname: Fujii
authors.forename: Gen
authors.initials: G
authors.lastname: Nakanishi
authors.forename: Taishi
authors.initials: T
authors.lastname: Nagao
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D000505:Alopecia / Q000139:chemically induced* / Q000473:pathology; D000970:Antineoplastic Agents / Q000009:adverse effects*; D044466:Asian People; D001932:Brain Neoplasms / Q000188:drug therapy / Q000556:secondary; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000556:secondary; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D005260:Female; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology; D011799:Quinazolines / Q000009:adverse effects*; D012536:Scalp Dermatoses / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D066246:ErbB Receptors; D000077156:Gefitinib