PubMed · 10955186
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J H Kuflik, R A Schwartz. 2000. Acneiform eruptions.. https://pubmed.ncbi.nlm.nih.gov/10955186/
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INTRODUCTION: Many drugs may induce acneiform eruptions: vitamine B12, corticosteroids, androgens, lithium, tuberculostatics, halogens, some antidepressants, anticonvulsives and immunosuppressors. Many cases of acneiform eruptions can be observed following treatment with cetuximab, a drug used for solid cancers at advanced stages in experimental protocols. CASE REPORTS: Case 1. A 56 year-old woman, suffering from a colorectal cancer, developed a sudden acneiform eruption after 6 cures of cetuximab, at a one-week interval. She was treated with bisoprolol hemifumarate, sodium levothyroxin, cyproterone acetate and estradiol valerate. Clinical examination revealed inflammatory and follicular papulopustules localized on the face and upper chest. Comedos were absent. Itching sensations were discrete. Histopathological examination of a papulopustule revealed a folliculitis with polymorphonuclear neutrophils. PAS staining did not reveal the presence of bacteria or yeasts. Bacterial and fungal cultures were negative. Lesions faded in approximately 2 weeks following minocycline treatment (100 mg/day). Case 2. A 65 year-old man, treated by cetuximab for a colorectal adenocarcinoma, suddenly developped follicular inflammatory papulopustules on the face, trunk and extensor surfaces of both arms, after 3 weeks of treatment. Itching was discrete. Comedos were absent. Histopathology revealed the presence of a folliculitis with polymorphonuclear neutrophils. Bacteriology and mycology were negative. Lesions were partly controlled by administration of minocycline (100 mg/day) but worsened again in the days following each cure of cetuximab. DISCUSSION: Cetuximab is a monoclonal antibody binding to the epidermal-growth-factor-receptor. It is used in the treatment of solid cancers at advanced stages. Both case reports share some similarities: the development of follicular inflammatory papulopustules distributed on the face and trunk typical, of acneiform drug eruptions. Itching is discrete. Comedos are absent. Quick onset of lesions is the rule. Cetuximab can be added to the list of drugs responsible for acneiform eruption.
BACKGROUND: Chloracne is an acneiform eruption due to poisoning by halogenated aromatic compounds having a specific molecular shape. This condition is always a symptom of systemic poisoning by chemical chloracnegens and not just a cutaneous disorder. METHODS: We have studied a patient with severe chloracne who showed cutaneous lesions involving mostly the face and the axillae. RESULTS: Histopathologic study of the facial lesions demonstrated that almost every vellus hair follicle was involved, showing a dilated infundibulum filled by a keratotic plug. This keratotic material was mostly composed of orthokeratotic basket-weave basophilic corneocytes, namely infundibular keratin, although there were also some dilated infundibula containing eosinophilic laminated or granular sebum at their center. Small infundibular cysts were more numerous than comedones. Mature and well-developed sebaceous glands were seen at the base of many of the dilated infundibula and no squamous metaplasia of the sebaceous glands or ducts could be demonstrated. Hyperpigmentation of the lesions resulted from hyperproduction of melanin by a normal number of melanocytes along the basal layer of the epidermis and infundibular epithelium. Abundant melanin granules also impregnated the corneocytes of the infundibular plugs. CONCLUSIONS: Our findings support the notion that tiny infundibular cysts rather than comedones represent the basic lesions of chloracne.
We report the cutaneous side-effects of ZD1839 (Iressa), a new anticancer agent that acts by inhibiting epidermal growth factor (EGF) receptor signal transduction. Three patients receiving ZD1839 developed an eruption consisting of follicular papules and pustules in an acneiform distribution as well as diffuse fine scaling of the skin. Additionally, hair growth abnormalities were noted in two patients. Histologically, a superficial purulent folliculitis and disordered differentiation with focal parakeratosis were seen. The follicular eruption appeared to respond favourably to treatment with tretinoin cream and minocycline. The cutaneous adverse effects of ZD1839 are similar to those of other EGF receptor-targeted agents and result from direct interference with the functions of EGF receptor signalling in the skin.