Development of Multiple Paronychia and Periungual Granulation in Patients Treated with Gefitinib, an Inhibitor of Epidermal Growth Factor Receptor

Tracheal granuloma pyogenicum with erlotinib treatment for lung cancer

“…In several severe cases, inflammation of the nail fold was described with development of a pyogenic granuloma. Our patient had not developed any relevant symptoms or nail changes [6,7,8,9].…”

Cutaneous side effects of epidermal growth factor receptor inhibitors: Clinical presentation, pathogenesis, and management

“…Hyperpigmentation, trichomegaly, and telangiectasia are less commonly seen. 5,[21][22][23][24][25][26][27][28][29][30][31] The monoclonal antibodies and tyrosine kinase inhibitors appear to possess a class-specific cutaneous side-effect profile likely due to their overall inhibition of EGFR. 21,32 ACNEIFORM ERUPTION Acneiform eruptions occur in more than 50% of cases, although cetuximab can demonstrate incidences as high as 75% to 100% of cases.…”

“…36 PARONYCHIA Paronychia occurs less frequently than acneiform eruptions, with some authors estimating its occurrence in 10% to 15% of patients treated with cetuximab and gefitinib. 21,24,[26][27][28][29]78,79 It typically develops approximately 4 to 8 weeks, and sometimes as late as 6 months, after treatment initiation and frequently involves multiple fingers and the great toes (Fig 2). 21,[26][27][28][29]78,79 Paronychia may be painful, particularly when associated with ingrowth of the nails.…”

“…78 In severe cases, periungual abscesses and pyogenic granulomaelike growths can develop near the nailfolds. 24,27,28,79 Secondary infection with S aureus or methicillin-resistant S aureus may also occur. 24,27,28 Histopathology…”

“…[27][28][29] Vessels with prominent endothelial cells within an edematous stroma are also seen in the dermis. 27,29 There has been no evidence of Candida species, bacteria, or fungi on cultures when secondary infection with S aureus is not present.…”