Management of Papulo-pustular Rash Induced by Epidermal Growth Factor Receptor Inhibitors

Epidermal growth factor receptor inhibitors (EGFRI) are used for the treatment of advanced colorectal, head and neck, pancreatic, and non-small cell lung cancers. Although EGFRI have a much better tolerability profile compared with conventional cytotoxic drugs, they are associated with significant skin toxicity. The most frequent dermatologic side effect is the papulo-pustular rash (PPR). It often leads to dose reductions or discontinuation of therapy. However, therapeutic response and survival are directly proportional to PPR severity. Patients with severe PPR should not discontinue treatment as they are expected to have the best clinical outcome. Therefore, prophylactic treatment or prompt intervention are essential for rash management and maintenance of patient tolerance and compliance. Further studies are urgently needed in order to establish evidence-based approach algorithms to the management of EGFRI induced skin toxicity and to optimize the benefits of this antineoplastic therapy. Our aim is to discuss the clinical presentation, pathophysiology, and treatment options in EGFRIinduced PPR.