title: Histopathologic features of erythematous papulopustular eruption to epidermal growth factor receptor inhibitors in cancer patients.
abstract: BACKGROUND
  Erythematous papulopustular eruption (EPPE) is the most frequent skin adverse event to epidermal growth factor receptor (EGFR) inhibitors but its histopathologic features have been poorly studied. As EPPE is a strong predictor of patient's treatment response, the EPPE histopathologic features and their correlations with skin eruption severity and involved drug were investigated.
  
  
  METHODS
  An involved skin biopsy was carried out in 39 informed patients treated with EGFR inhibitors (mainly cetuximab and erlotinib). The cutaneous changes in hematoxylin-eosin stained sections were evaluated.
  
  
  RESULTS
  The EPPE to EGFR inhibitors is histopathologically characterized by neutrophilic subcorneal or intraepidermal pustules and polymorphous infiltrate of the superficial dermis during the earliest phases and by lymphocytic perifolliculitis and/or suppurative folliculitis at a later phase. The widespread dermis inflammation was more frequent in severe EPPEs and in patients treated with cetuximab, while the hair follicle inflammation was observed only in mild/moderate EPPEs.
  
  
  CONCLUSIONS
  Our study shows the histopathologic signs of EPPE and their correlation with clinical severity and the offending drug.
authors.affiliation: Clinical, Allergological and Venereological Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy.
authors.forename: V
authors.identifier: http://orcid.org/0000-0001-5194-6785
authors.initials: V
authors.lastname: Bellini
authors.affiliation: Clinical, Allergological and Venereological Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Bianchi
authors.affiliation: Clinical, Allergological and Venereological Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Pelliccia
authors.affiliation: Clinical, Allergological and Venereological Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Lisi
mesh_terms: D000328:Adult; D000368:Aged; D000068818:Cetuximab / Q000009:adverse effects* / Q000494:pharmacology; D003875:Drug Eruptions / Q000378:metabolism / Q000473:pathology; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D000069347:Erlotinib Hydrochloride / Q000009:adverse effects* / Q000494:pharmacology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000378:metabolism / Q000473:pathology
chemical_list: D000069347:Erlotinib Hydrochloride; C512478:EGFR protein, human; D066246:ErbB Receptors; D000068818:Cetuximab
keywords: epidermal growth factor receptor inhibitors; erythematous papulopustular eruption; histopathology; side effects; skin toxicity