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Cutaneous appendages depend on EGFR signalling for normal development and function. Consequently, alterations in the hair and nails develop in EGFRI-treated patients.1 Approximately 90% of patients treated with EGFRIs for longer than 6 months exhibit hair changes.2

Definition: Very characteristic changes are long, curly, rigid eyelashes – a condition known as Trichomegaly. This may lead to eye irritation, conjunctivitis or Blepharitis. In addition, the eyebrows become thicker and more rigid, while the scalp hairs grow more slowly and adopt a finer, more brittle and curly aspect.3,4 Also less shavings of the beard are required and mild hair loss can be seen on the scalp – sometimes in an androgenetic pattern. Hypertrichosis, with small vellus hairs, may develop on the face and the female lip.3,4

Trichomegaly of the eyelashes in EGFRI-treated patients resembles the long, curly whiskers seen in transgenic mice expressing a dominant-negative mutation of EGFR in the epidermis.5

Incidence: Common.6,7,8,9,10

Onset: More than 8 weeks after treatment initiation.

Resolution: Only within months of completion of EGFRI treatment.

ICD10 code:

  • L68 Hypertrichosis.

Grade 1

Increase in length, thickness or density of hair that the patient is either able to camouflage by periodic shaving or removal of hairs, or is not concerned enough about the overgrowth to use any form of hair removal.

Typical clinical presentations of grade 1 hair changes can be viewed at the bottom of the page.

Grade 2

Increase in length, thickness or density of hair at least on the most commonly exposed areas of the body (face [not limited to beard/moustache area] plus/minus arms) that requires frequent shaving or use of destructive means of hair removal to camouflage; associated with psychosocial impact.

Typical clinical presentations of grade 2 hair changes can be viewed at the bottom of the page.

References

1Lacouture ME. Nat Rev Cancer 2006; 6: 803-812.
2Osio A et al. Br J Dermatol 2009; 161: 515-521.
3Segaert S & Van Cutsem E. Ann Oncol 2005; 16: 1425-1433.
4Robert C et al. Lancet Oncol 2005; 6: 491-500.
5Murillas R et al. EMBO J 1995; 14: 5216-5223.
6European Medicine Agency. Tarceva® (erlotinib) Summary of Product Characteristics 2009.
7European Medicine Agency. Iressa® (gefitinib) Summary of Product Characteristics 2009.
8European Medicine Agency. Erbitux® (cetuximab) Summary of Product Characteristics 2009.
9European Medicine Agency. Vectibix® (panitumumab) Summary of Product Characteristics 2009.
10European Medicine Agency. Tyverb® (lapatinib) Summary of Product Characteristics 2010.

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