Clinical features and treatment of epidermal growth factor inhibitor-related late-phase papulopustular rash.
Clinical features and treatment of epidermal growth factor inhibitor-related late-phase papulopustular rash.
复制标题
表皮生长因子抑制剂相关的晚期丘疹脓疱性皮疹的临床特征和治疗。
DOI：
10.1111/1346-8138.15170
复制
发表时间：
2019
期刊：
影响因子：
3.1
通讯作者：
Nishina T.
中科院分区：
文献类型：
--
作者：
Tohyama M;Hamada M;Harada D;Kozuki T;Nogami N;Monden N;Kajiwara T;Nishina T.
丘疹脓疱性皮疹是一种痤疮样皮疹，在用表皮生长因子受体抑制剂（EGFRi）治疗的第一至第二周期间出现在脂溢性区域。皮疹在第四周后逐渐消失;然而，在EGFRi治疗期间，它在其他区域持续存在或新发。由于金黄色葡萄球菌经常从晚期丘疹脓疱性皮疹中分离出来，我们评估了晚期丘疹脓疱性皮疹患者的细菌感染发生率和治疗结局。回顾性评估了64例接受EGFRi治疗4周以上的丘疹脓疱性皮疹病例。EGFR抑制剂治疗的中位持续时间为5个月。分别在47例和8例病例中观察到2级和3级丘疹脓疱性皮疹。在51例病例中进行了细菌培养，其中50例获得阳性结果：甲氧西林敏感金黄色葡萄球菌29例，甲氧西林耐药金黄色葡萄球菌14例，葡萄球菌属5例，铜绿假单胞菌3例，其他4例。金黄色葡萄球菌中，42%对米诺环素耐药，40%对左氧氟沙星耐药。在局部和/或口服抗生素而不使用局部皮质类固醇治疗后，丘疹脓疱性皮疹迅速改善，平均改善2.9 ± 3.4周。然而，联合使用抗生素和局部皮质类固醇将恢复期延长至平均18.9 ± 11.4周。总之，在EGFRi治疗开始后超过4周发生的毛囊炎通常是由葡萄球菌感染引起的。细菌培养是必要的，因为抗生素耐药率很高。重要的是要区分晚期和早期丘疹脓疱性皮疹，并使用不同的方法治疗。
Papulopustular rash, an acneiform rash, appears on the seborrheic region during the first to second week of treatment with an epidermal growth factor receptor inhibitor (EGFRi). The rash gradually disappears after the fourth week; however, it persists or newly develops in other regions during EGFRi treatment. BecauseStaphylococcus aureusis frequently isolated from late‐phase papulopustular rash, we assessed the incidence of bacterial infection and treatment outcomes of patients with late‐phase papulopustular rash. Sixty‐four cases treated with an EGFRi over 4 weeks who presented with papulopustular rash were assessed retrospectively. The median duration of EGFR inhibitor treatment was 5 months. Grade 2 and 3 papulopustular rash was observed in 47 and eight cases, respectively. Bacterial culture was performed in 51 cases, 50 of which yielded positive results: methicillin‐sensitiveS. aureusin 29, methicillin‐resistantS. aureusin 14,Staphylococcusspecies in five,Pseudomonas aeruginosain three, and other in four cases. Of theS. aureusisolates, 42% were resistant to minocycline and 40% to levofloxacin. After treatment with topical and/or oral antibiotics without topical corticosteroids, the papulopustular rash rapidly improved by an average of 2.9 ± 3.4 weeks. However, use of a combination of antibiotics and a topical corticosteroid prolonged the recovery period to an average of 18.9 ± 11.4 weeks. In conclusion, folliculitis that develops over 4 weeks after the initiation of EGFRi treatment is typically caused by staphylococcal infection. Bacterial culture is necessary due to the high rate of antibiotic resistance. It is important to distinguish late‐ from early‐phase papulopustular rash and to treat using different approaches.