Abstract
Here we discuss the dramatic cutaneous reactions of two patients receiving targeted therapies for cancer (one on a MEK inhibitor/BRAF inhibitor and the other receiving carfilzomib). Demodicosis was the underlying cause in both cases, though the infection was mistaken for a reaction to the patients’ complex malignancy therapies. Given the prevalence of cutaneous side effects of chemotherapy and targeted cancer therapies and the protean nature of demodicosis, it follows that demodicosis may be easily mistaken as a drug reaction to a chemotherapeutic agent. Demodicosis in the setting of chemotherapy and immunosuppression must thus remain an important diagnostic consideration in patients undergoing cancer treatment to allow for appropriate diagnosis and management of cutaneous findings without discontinuation of essential chemotherapy.
Highlights
We discuss the dramatic cutaneous reactions of two patients receiving targeted therapies for cancer
A woman in her 50s receiving vemurafenib 480mg twice daily and trametinib 2mg daily for anaplastic astrocytoma presented to oncodermatology clinic with a 6-month history of persistent papulopustular eruption involving the face and scalp
Demodicosis has been associated with several immunomodulatory agents, including topical or systemic steroids, monoclonal antibody therapies like cetuximab and panitumumab[4], and biologics like dupilumab[5]
Summary
We discuss the dramatic cutaneous reactions of two patients receiving targeted therapies for cancer (one on a MEK inhibitor/BRAF inhibitor and the other receiving carfilzomib). The lesions were not pruritic nor painful She received doxycycline 100mg twice daily and triamcinolone 0.1% cream for the face and fluocinonide 0.05% solution for the scalp for suspected cutaneous reaction to MEK inhibitor/BRAF inhibitor (BRAFi/MEKi) therapy. Her eruption persisted over the five months despite treatment with various oral antibiotics, topical antibiotics, and topical steroids. Approximately two weeks after switching therapy to daratumumab, he was hospitalized for cancer-related complications and worsening pruritic facial eruption His physical exam revealed excoriated, erythematous, folliculocentric papules, deep nodules, and pustules on the bilateral temples, cheeks, ears, scalp, forehead, and posterior neck (Figure 2a). He received 15mg of oral ivermectin (two doses, 1 week apart) for the treatment of demodicosis, achieving complete resolution at two-week follow-up (Fig 2b)
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