Abstract

Cetuximab is an epidermal growth factor receptor (EGFR) inhibitor that commonly results in follicular-based acneiform eruptions. EGFR is expressed in the epidermis, hair follicle epithelium, sweat gland apparatus, and plays an important role in the differentiation and development of the hair follicle. In this report we describe a 70-year-old man who developed an acneiform eruption on his nose, cheeks, neck, and back when cetuximab was started for metastatic colorectal carcinoma. This initial eruption improved with cessation of cetuximab but left residual cystic papules on his nose and multiple superficial white cysts on his bilateral cheeks, neck and back. Skin biopsy of a representative lesion on the nose revealed a cyst-like cavity lined with epithelium similar to sweat glands within the dermis consistent with a hidrocystoma. In this case, it is plausible that the use of an EGFR inhibitor resulted in a cutaneous inflammatory reaction, that subsequently healed with blockage of the sweat duct apparatus causing the formation of cutaneous cysts, including both hidrocystomas and milia. Alternatively, the blockage of the duct may have resulted from inhibition of basal cell migration and increased cell adhesion within the eccrine gland causing accumulation of eccrine gland secretion, and eventually hidrocystomas. To our knowledge, this is the first case describing the resolution of a typical cetuximab-induced acneiform eruption with residual hidrocystomas and milia.

Highlights

  • Cetuximab is an IgG1 chimeric monoclonal antibody targeting epidermal growth factor receptor (EGFR) that is approved to treat several malignancies, including colorectal cancer and squamous cell carcinoma of the head and neck

  • We present a case of an elderly woman that developed an acneiform eruption following the start of cetuximab therapy as part of a polychemotherapy regimen for treatment of colorectal cancer

  • EGFR is expressed in the epidermis, hair follicle epithelium, sweat gland apparatus, and plays an important role in the normal differentiation and development of the hair follicle.[1]

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Summary

INTRODUCTION

Cetuximab is an IgG1 chimeric monoclonal antibody targeting epidermal growth factor receptor (EGFR) that is approved to treat several malignancies, including colorectal cancer and squamous cell carcinoma of the head and neck. We present a case of an elderly woman that developed an acneiform eruption following the start of cetuximab therapy as part of a polychemotherapy regimen for treatment of colorectal cancer. To our knowledge, this is the first case describing the resolution of the typical cetuximab-induced acneiform eruption that resulted in residual hidrocystomas on the nose and milia on the cheeks, neck, and back

CASE PRESENTATION
DISCUSSION

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