Erlotinib induced ectropion following papulopustular rash

Abstract

Background: Erlotinib is a targeted anti-cancer drug which acts through the inhibition of epidermal growth factor receptor (EGFR). Main observations:A 79-year-old developed bilateral ectropion after he received erlotinib treatment for lung adenocarcinoma. The ectropion completely resolved with symptomatic treatment without any modification in erlotinib therapy.Conclusions: EGFR inhibitors are frequently associated with a variety of mucocutaneous adverse events. Ocular toxicity associated with these agents has been reported rarely. We present this case to underline the importance of recognition of newly reported cutaneous and ocular adverse events of targeted therapies. (J Dermatol Case Rep. 2015; 9(2) IntroductionChemotherapeutic agents may be the cause of a wide spectrum of dermatological adverse events affecting the skin, skin appendages and mucous membranes. These adverse events are largely dependent on these agents' mechanism of action in cancer treatment. Recently developed targeted agents in cancer therapy are effective by acting on specific pathways and molecules and are therefore less frequently associated with systemic side effects compared with standard chemotherapy. Basal keratinocytes of the epidermis, hair follicles, sebaceous and eccrine epithelium, corneal, limbal and conjunctival epithelium are among the EGFR expressing cells and tissues. [1][2][3] The major functions of the EGFR in the skin are regulation of proliferation, differentiation, migration, apoptosis of cells and stimulation of keratinocyte migration and epidermal growth. 1 Therefore, despite their relative safety in terms of systemic toxicity, mucocutaneous side effects are seen rather frequently with EGFR inhibitors. Case reportA 79-year-old man presented with one-week-history of rash involving his face. He was on his second week of erlotinib treatment for lung adenocarcinoma. His past medical history was insignificant except for hypertension, vertigo and his medications included amlodipine and betahistine. Dermatological examination revealed monomorphic, erythematous papules and pustules over the centrofacial region. Based on the clinical findings, a diagnosis of erlotinib DOI: http://dx.doi.org/10.3315/jdcr.2015.1203 46 induced papulopustular rash was made. Treatment with hydrocortisone acetate cream twice daily for three days and sodium sulfacetamide lotion twice daily was commenced. After 3 weeks of treatment, his skin lesions completely resolved but he complained of recently developed burning sensation and dryness in his eyes. Bilateral ectropion of the lower eyelids were noted on physical examination and the patient was referred to ophthalmology department with a presumptive diagnosis of erlotinib induced ectropion (Fig. 1). Ophthalmological examination showed blepharitis, tear film dysfunction leading to dry eye and bilateral ectropion of the lower eyelids. As these findings were mild, no modification in erlotinib treatment was required and the ectropion ameliorated with symptomatic treatment in three weeks. The pati...

Drug-induced ectropion following the chronic use of topical Natamycin

“…Drug-induced ectropion is a rare condition secondary to drug hypersensitivity. It was reported following administration of topical and systemic medications [1][2][3][4][5][6][7]. Among topical drugs, anti-glaucoma medications were the most reported drugs causing periorbital dermatitis and ectropion; however, other topical agents such as topical 5% fluorouracil cream and topical Tretinoin were described in the literature [4,5].…”

Dramatic Improvement of Severe Cicatricial Ectropion after Discontinuing Long-Term Erlotinib Therapy in a Patient with Lung Cancer

“… 1 It is frequently used in the treatment of lung cancer and may cause ocular toxicity. 1 , 2 , 3 , 4 Ocular complications range widely from mild dry eye syndrome to corneal perforation that requires corneal transplantation. 1 , 2 , 3 , 4 It is reported in the literature that erlotinib-related ocular complications usually occur early in treatment (within the first 6 weeks) and resolve slowly (after 6 weeks).…”

“… 1 , 2 , 3 , 4 Ocular complications range widely from mild dry eye syndrome to corneal perforation that requires corneal transplantation. 1 , 2 , 3 , 4 It is reported in the literature that erlotinib-related ocular complications usually occur early in treatment (within the first 6 weeks) and resolve slowly (after 6 weeks). 1 , 2 , 3 , 4 To our knowledge, there is no case report of a patient with both ocular toxicity after long-term use that shows dramatic improvement with drug cessation, and severe cicatricial ectropion causing eversion of the entire lower eyelid.…”

“… 1 , 2 , 3 , 4 It is reported in the literature that erlotinib-related ocular complications usually occur early in treatment (within the first 6 weeks) and resolve slowly (after 6 weeks). 1 , 2 , 3 , 4 To our knowledge, there is no case report of a patient with both ocular toxicity after long-term use that shows dramatic improvement with drug cessation, and severe cicatricial ectropion causing eversion of the entire lower eyelid. Furthermore, there is no consensus regarding the choice of systemic and ophthalmic treatment in patients who develop ocular toxicity with erlotinib in previous studies.…”

“…Furthermore, there is no consensus regarding the choice of systemic and ophthalmic treatment in patients who develop ocular toxicity with erlotinib in previous studies. 1 , 2 , 3 , 4 Here, we described a patient who used erlotinib for 3 years due to non-small cell lung cancer and developed severe cicatricial ectropion which improved dramatically within one week of temporarily discontinuing erlotinib, and we discussed the possible reasons.…”