Definition: Acneiform rash (‘rash’; also referred to as acneiform eruption, acne-like rash, papulopustular rash or Folliculitis) is characterised by Follicular, papulopustular eruptions confined to the seborrheic areas, frequently localised to the face, scalp, upper chest and back.1,2

The eruption is more or less confined to the seborrheic areas (rich in Sebaceous glands): the face (especially the nose, cheeks, forehead and chin), scalp, neck and retroauricular area, shoulders and upper trunk (where the rash typically presents in a V-shaped pattern reflecting the density of the Sebaceous glands in this skin area). Sometimes the lower parts of the back, the abdomen, the buttocks and even the arms and legs can be involved; however, the palms of the hands and soles of the feet (which have no hair Follicles) are spared.1,2,3,4,5,6,7,8

Incidence: Rash is a class-effect of the EGFRIs and is seen in most patients.9,10,11,12,13

Onset: From a few days to some weeks following treatment initiation, reaching a maximum after approximately 3 weeks.1,3

Resolution: The rash is reversible and usually fades gradually with ongoing EGFRI treatment; complete resolution is seen after completion of EGFRI treatment.1,3

ICD10 codes:

  • L27.0 Generalised skin eruption due to drugs and medicaments.
  • L27.1 Localised skin eruption due to drugs and medicaments.
  • Y43.8 Other drugs, medicaments and biological primarily systemic substances causing adverse effects in therapeutic use, not elsewhere classified.

Mild rash

From a clinical point of view and with respect to treatment allocation, it would be helpful to describe mild rash as the occurrence of lesions with or without only mild symptoms, covering a limited body surface area (BSA). (This refers to the BSA actually covered by a lesion and does not refer to the BSA over which lesions are spread.)

The corresponding NCI-CTCAE v4.03 definition for ‘Grade 1 Acneiform rash’ reads: Papules and/or Pustules covering <10% BSA, which may or may not be associated with symptoms of Pruritus or tenderness.

Typical clinical presentations of mild rash can be viewed in the gallery at the bottom of the page.

Moderate rash

Moderate rash consists of either marked papulopustular lesions and/or lesions that cover a larger BSA and/or are associated with moderate symptoms (Pruritus, tenderness, pain).

The corresponding NCI-CTCAE v4.03 definition for ‘Grade 2 Acneiform rash’ reads: Papules and/or Pustules covering 10-30% BSA, which may or may not be associated with symptoms of Pruritus or tenderness; associated with psychosocial impact; limiting instrumental activities of daily living (ADL: refers to preparing meals, shopping for groceries or clothes, using the telephone, managing money etc).

Typical clinical presentations of mild rash can be viewed in the gallery at the bottom of the page.

Severe rash

Severe rash consists of either severe acneiform lesions (confluent Pustules, marked oedema, necrosis, ulceration) and/or lesions that are very extensive and/or are associated with severe symptoms (Pruritus, tenderness, pain).

The largely corresponding NCI-CTCAE v4.03 definition for ‘Grade 3 Acneiform rash’ reads: Papules and/or Pustules covering >30% BSA, which may or may not be associated with symptoms of Pruritus or tenderness; limiting self care ADL (refers to bathing, dressing and undressing, feeding self, using the toilet, taking medications, and not confined to bed); associated with local superinfection with oral antibiotics indicated.

The largely corresponding NCI-CTCAE v4.03 definition for the extremely rare ‘Grade 4 Acneiform rash’ reads: Papules and/or Pustules covering any % BSA, which may or may not be associated with symptoms of Pruritus or tenderness and are associated with extensive superinfection with intravenous (i.v.) antibiotics indicated; life-threatening consequences.

Typical clinical presentations of mild rash can be viewed in the gallery at the bottom of the page.

References

1Segaert S & Van Cutsem E. Ann Oncol 2005; 16: 1425-1433.
2Lacouture ME. Nat Rev Cancer 2006; 6: 803-812.
3Roé E et al. J Am Acad Dermatol 2006; 55: 429-437.
4Van Doorn R et al. Br J Dermatol 2002; 147: 598-601.
5Busam KJ et al. Br J Dermatol 2001; 144: 1169-1176.
6Pascual JC et al. Br J Dermatol 2005; 153: 1222-1223.
7Walon L et al. Ann Dermatol Venereol 2003; 130: 443-446.
8Jacot W et al. Br J Dermatol 2004; 151: 238-241.
9European Medicine Agency. Tarceva® (erlotinib) Summary of Product Characteristics 2009.
10European Medicine Agency. Iressa® (gefitinib) Summary of Product Characteristics 2009.
11European Medicine Agency. Erbitux® (cetuximab) Summary of Product Characteristics 2009.
12European Medicine Agency. Vectibix® (panitumumab) Summary of Product Characteristics 2009.
13European Medicine Agency. Tyverb® (lapatinib) Summary of Product Characteristics 2010.

This site uses cookies. Some of these cookies are essential, while others help us improve your experience by providing insights into how the site is being used.

For more detailed information on the cookies we use, please check our Privacy Policy.

Customise settings