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Semiology of skin toxicity associated with epidermal growth factor receptor (EGFR) inhibitors

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Abstract

Purpose

Advances in the understanding of the mechanisms involved in oncogenesis have led to the development of so-called targeted therapies such as epidermal growth factor receptor (EGFR) inhibitors, which take on an increasingly important role in the management of cancer. These treatments have the advantage not to trigger the adverse effects traditionally encountered with chemotherapy, such as nausea, vomiting or haematological toxicity. However, they do cause new forms of toxicity: the most common one is skin toxicity. It is important to be aware of it because it can be debilitating, adversely impacting patients’ quality of life and altering treatment compliance, although it appears to be correlated with treatment response in certain series. Non-specialists can have difficulty in recognising this unusual skin toxicity.

Methods

The dermatologic side effects most frequently triggered by EGFR inhibitors are discussed in this article.

Results

They are divided into three categories depending on their target: inflammation of the pilo-sebaceous follicle, represented by EGFR inhibitor-associated folliculitis, which occurs at an early stage and is frequent; alteration in the skin barrier, primarily responsible for xerosis, fissures and pruritus, which are frequent and delayed; and lesions of the skin appendages (paronychia, pyogenic granuloma, hair changes), which are delayed and less frequent.

Conclusion

It is essential for all practitioners concerned to know about these dermatologic side effects in order to ensure better global management of patients, particularly in terms of quality of life.

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Acknowledgements

Pr JY Douillard, MD, PhD, for his advice.

Photographs have been kindly provided by Dr L Peuvrel (all figures except Fig. 14) and Dr JB Bachet (Fig. 14).

Funding source Amgen Laboratory

Conflict of interest None reported

Author information

Authors and Affiliations

  1. Department of Dermato-Cancerology, Nantes University Hospital; CIC biotherapy INSERM 0305, 1 place Ricordeau, 44000, Nantes, France

    L. Peuvrel & B. Dréno

  2. Department of Internal Medicine, Hôpital Tenon, Assistance Publique—Hôpitaux de Paris, Paris, France

    C. Bachmeyer

  3. Department of Dermatology, CH Robert Debré, Reims, France

    Z. Reguiai

  4. Department of Hepato-Gastro-Enterology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique—Hôpitaux de Paris, Université Pierre & Marie Curie (UPMC); GERCOR, Paris, France

    J. B. Bachet

  5. Department of Medical Oncology, Hôpital St Antoine, Assistance Publique—Hôpitaux de Paris, Université Pierre & Marie Curie (UPMC); GERCOR, Paris, France

    T. André

  6. Radiation Oncology Department, Faculty of Medicine, Poitiers University Hospital, Poitiers, France

    R. J. Bensadoun

  7. Department of Hepato-Gastro-Enterology and Gastro-Intestinal Oncology, CHU Reims, Reims, France

    O. Bouché

  8. CRLCC Val d’Aurelle, Montpellier, France

    M. Ychou

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  1. L. Peuvrel
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Corresponding author

Correspondence to B. Dréno.

Appendix

Appendix

Glossary: dermatological semiology [36]

Macula: a flat, non-infiltrated lesion, characterised by a change in skin colour

Erythema: a red or pinkish lesion, disappearing on vitropressure corresponding to vasodilatation

Purpura: a dark red lesion that does not disappear on vitropressure corresponding to extravasation of the red blood cells

Papula: a solid raised lesion, less than one centimetre in diameter

Nodule: a solid raised lesion, greater than 1 cm in diameter

Plaque: a solid raised flat-topped lesion, greater than 1 cm in diameter

Vesicle: a raised lesion, filled with clear liquid, less than 1 cm in diameter

Bulla: a raised lesion, filled with liquid, more than 1 cm in diameter

Pustule: a raised lesion, filled with pus

Telangiectasia: permanent dilatations of superficial blood vessels in the skin

Scale: flakes or plates that represent compacted desquamated layers of stratum cornea that become detached from the epidermis

Crust: exudates coagulation on the surface of inflamed skin

Lichenification: a thickening of the epidermis, which appears with exaggeration of normal skin lines, usually due to chronic scratching

Fissure: linear cleavage of the skin

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Peuvrel, L., Bachmeyer, C., Reguiai, Z. et al. Semiology of skin toxicity associated with epidermal growth factor receptor (EGFR) inhibitors. Support Care Cancer 20, 909–921 (2012). https://doi.org/10.1007/s00520-012-1404-0

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