Scalp Pustules in a Patient Receiving Chemotherapy

Abstract

An85-year-oldmanwith lungcancer (stage IV, adenocarcinoma)was treatedwith theepidermal growth factor receptor [EGFR] inhibitor gefitinib (250 mg/d). One month later, he developed a few erythematous follicular papules with focal scaling on the scalp, which intermittently improvedandworsenedandwerereasonablywell controlledwith topical corticosteroids. Neither pustules nor hair loss was noted. The cancerwaswell controlled for 31months,whenhis tumor recurredand hewas switched to erlotinib (150mg/d). Subsequently, thenumber of scalp lesions increased, accompanied by pustules and hair loss. Numerous pustules with an erythematous base were observed on the scalp vertex (Figure1).Paronychia,pruritus,anddryskin were also present, but the pustular eruption was limited to the scalp. Neither fever nor other constitutional symptomswere noted. Testing of thescalp lesionsusingapotassiumhydroxide (KOH)preparationproduced negative results. Figure 1.