INTRODUCTION
Epidermal growth factor receptor inhibitors (EGFRIs) are utilized to treat many cancers of epithelial origin. Papulopustular eruptions (PPEs) are the most common cutaneous complication of EGFRIs, occurring in up to 90% of patients.1 Cutaneous complications arise due to high EGFR levels in the basal cells of the epidermis, hair shaft, sebaceous glands, and outer root sheath.2 EGFRs play a crucial role in the normal development and homeostasis of the skin as well as in the inflammatory functions of the epidermis.3 EGFR signaling has been implicated in innate immunity and chronic inflammation. While the exact pathophysiology has not been fully elucidated, EGFRI-associated PPEs are postulated to result from disrupted homeostatic and innate immune mechanisms of the epidermis, leading to skin inflammation.3 PPEs generally arise a few weeks after EGFRI initiation and often cause significant pruritus and burning.4 Although PPEs are an indicator of drug efficacy, the symptoms can significantly affect patients' quality of life and lead to reduction, interruption, and even discontinuation of anti-cancer therapies.5 Given that EGFRIs are essential to survival, appropriate management of PPEs without compromising anti-cancer therapy is critical. Topical corticosteroids and oral tetracyclines used prophylactically and reactively have been the mainstay of management for these eruptions, though are limited by their adverse effects.2,5 Thus, finding alternative, effective, and safe treatment options is imperative. In this report, we document the first clinical case of EGFRI-associated PPE to respond to aprepitant (HT-001) 2% cream.
Case History
A 59-year-old female with a history of metastatic breast cancer with bilateral lung nodules managed with THP (Taxol, Herceptin, and Perjeta) and weekly Abraxane presented to our clinic with pruritic, burning erythematous papules on her face, scalp, and upper back which began roughly two weeks after treatment initiation (Figure 1). Per her oncologist's recommendation, the patient had tried Selsun Blue shampoo, which offered minimal relief. On exam, there were 19 inflammatory papules scattered across the parietal scalp bilaterally and posterior scalp, 4 eroded papules on the posterior neck and upper back, prominent facial erythema, and minuscule papules on the cheeks bilaterally. The patient was only interested in topical therapies and a trial of aprepitant (HT-001) 2% cream was initiated. The patient was instructed to use the cream twice daily for one month. However, at her one-month follow-up, the patient reported
Case History
A 59-year-old female with a history of metastatic breast cancer with bilateral lung nodules managed with THP (Taxol, Herceptin, and Perjeta) and weekly Abraxane presented to our clinic with pruritic, burning erythematous papules on her face, scalp, and upper back which began roughly two weeks after treatment initiation (Figure 1). Per her oncologist's recommendation, the patient had tried Selsun Blue shampoo, which offered minimal relief. On exam, there were 19 inflammatory papules scattered across the parietal scalp bilaterally and posterior scalp, 4 eroded papules on the posterior neck and upper back, prominent facial erythema, and minuscule papules on the cheeks bilaterally. The patient was only interested in topical therapies and a trial of aprepitant (HT-001) 2% cream was initiated. The patient was instructed to use the cream twice daily for one month. However, at her one-month follow-up, the patient reported
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