Bristol Cup Posters

[[abstract]]Several oncological drugs that target epidermal growth factor receptor (EGFR) have been developed over the last decade. For dermatologists, papulopustular or acneiform lesions are frequently seen in patients receiving EGFR inhibitors, including drugs such as cetuximab, getinib, erlotinib or afatinib, and development of a rash during therapy is thought to be an indicator of clinical responsiveness. Nevertheless, the dermatological manifestations can be somewhat variable and difcult to treat. In this study, we describe the clinicopathological ndings and therapeutic responses of papulopustular lesions in patients receiving EGFR inhibitors. We searched our department database for cases in which skin biopsy was performed for clinically diagnosed or suspected EGFR inhibitor-induced papulopustular eruptions. In total 22 patients were collected, including seven male and 15 female (age range 37 – 84 years, mean 61.5). Based on the clinical characteristics, the eruptions were classied into three groups: acne-like papulopustules affecting mainly the face and anterior chest (n = 5), purpuric vasculitis-like lesions with uniform purpuric pustules on the extremities and trunk (n = 9) and tinea capitis-like eruptions with follicular pustules or ulcers on the scalp (n = 8). The mean SD onset times for each subtype of eruption were 2.2 0.5, 18.6 6.3 and 10.5 2.3 weeks, respectively. The histopathology was characterized by suppurative and/or granulomatous folliculitis. Biopsies from acne-like papulopustules consisted mainly of dilated infundibula with intact pustules or very early ruptured follicles with focal granuloma formation. Purpuric vasculitis-like and tinea capitis-like lesions were often characterized by more supercial and larger infun dibular or subcorneal pustules with or without focal mild acantholysis. The hair follicles appeared more extensively damaged than in the acne-like lesions. By bacterial cultures and Gram stain, staphylococcal infection was more commonly identied in the purpuric vasculitis-like and tinea capitis-like groups than in the acne-like group, and the latter lesions were less responsive to systemic antibiotics. In summary we have identied three patterns of EGFR inhibitor-induced papul opustular eruptions, and our study highlights the importance of skin biopsy and bacterial culture in evaluating these patients