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Skin changes by EGFR inhibitors and risk factors for severe acneiform eruption


Epidermal growth factor receptor inhibitors ( EGFRi ), EGFR tyrosine kinase inhibitors ( TKI ) and anti‐EGFR antibodies commonly develop skin toxicities including acneiform eruption.
However, precise skin changes and risk factors for severe acneiform eruption are still unclear.

The objective of a study was elucidation of the useful parameters for early and sensitive detection of the skin changes by EGFRi.

Transepidermal water loss ( TEWL ), skin surface hydration, skin surface lipid levels and erythema / melanin index were serially measured for 2 weeks in 19 EGFR‐TKI Afatinib / Erlotinib‐treated patients and for 8 weeks in 20 anti‐EGFR antibody Cetuximab‐treated patients.

The TEWL levels of the cheek in the patients who developed acneiform eruption of grade 2 and more were already elevated at 7 days after the initiation of Afatinib / Erlotinib therapy compared with those before therapy as well as in patients with grade 1 or less.

In patients treated with Cetuximab, the skin surface hydration on the cheek in acneiform eruption of grade 2 and more patients significantly decreased compared with that of acneiform eruption of grade 1 or less patients at the 2nd and 6th week.

Baseline skin surface lipid levels and erythema index on the cheek of patients with acneiform eruption of grade 2 and more were significantly higher than those with acneiform eruption of grade 1 or less.

The small sample size of the present study, especially for logistic regression analysis, is a limitation.

In conclusion, instrumental evaluation declared rapid inflammatory changes of the skin by EGFR inhibitors and elucidated oily skin as a risk for severe acneiform eruption. ( Xagena )

Source: Journal of Dermatology, 2019

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