Today we're going to talk about a special topic: the "unexpected visitor" in cancer treatment – acne-like rashes.
You've all heard that cancer treatment can cause hair loss, but did you know? Some cancer drugs can also make patients have "pimples" all over their faces! Doesn't that sound a little incredible? But don't worry, we're going to find out today and see what the hell is going on.
1. A special case
Let's start with a real-world example:
Xiao Wang (pseudonym) is a 46-year-old lung cancer patient. After his diagnosis, his doctor prescribed him a targeted drug called afatinib. When I first started taking the medication, everything went well. But two weeks later, Xiao Wang suddenly noticed that a large number of red acne began to appear on his face, chest and back, itching and painful, looking like a severe pimple attack.
Xiao Wang was very distressed: "I'm so old, why do I still have so many acne?" Is it a side effect of the drug?"
With this question, Xiao Wang came to the dermatology department for treatment. After a detailed examination, the doctor told him, "The symptom you are experiencing now is called 'acne-like rash caused by EGFR inhibitors,' which is indeed one of the common side effects of drugs like afatinib."
- What are EGFR inhibitors?
Hearing this, I believe everyone, like Xiao Wang, will have a question: What is an EGFR inhibitor? Why does it cause this rash?
EGFR is an abbreviation for Epidermal Growth Factor Receptor. It acts like a "switch" on the surface of the cell that, when activated, promotes cell growth and division. In some cancers, this "switch" can be abnormally active, causing cancer cells to grow wildly.
EGFR inhibitors, on the other hand, are drugs specifically designed to "turn off" this abnormally active switch. They can effectively inhibit the growth of cancer cells and are a very important class of drugs in modern cancer treatment.
- Why do I have "pimples"?
So, why does the use of EGFR inhibitors cause skin rashes? It all starts with our skin.
Our skin, especially on the face, chest, and back, has a lot of EGFR. These EGFRs are normally responsible for regulating the growth, differentiation, and repair of skin cells. When we use EGFR inhibitors, although it mainly targets cancer cells, it also affects the EGFR of normal skin cells.
The result is:
- Slowed growth of skin cells
- Impaired skin barrier function
- Abnormal function of hair follicles and sebaceous glands
- The skin is susceptible to infection and inflammation
Combined, these changes create the acne-like rash we see.
- What are the symptoms?
Acne-like rashes caused by EGFR inhibitors usually appear within 1 to 3 weeks of taking the drug and are characterized by:
- Red papules and pustules appear on the face, chest, and back
- Dry, itchy skin
- In severe cases, it may be painful
- There may be inflammation around the nails
While these symptoms may look a lot like regular pimples, they actually have different mechanisms. Moreover, this rash tends to be more severe and widespread than ordinary acne.
- Is it serious? Do I need to stop taking the medication?
Seeing this, I believe that many patients and their families will be worried: does such a severe rash mean that the medicine is not suitable for me? Should I stop taking the drug?
Don't worry, let's see what the experts have to say:
First of all, although this rash may seem scary, in reality it does not mean that the treatment is not good. On the contrary, there are studies that show that patients who develop this rash may have better cancer treatments!
Second, in most cases, this rash can be controlled with appropriate treatment and does not require complete discontinuation of EGFR inhibitors.
However, if the rash is really severe and interferes with daily life, your doctor may consider temporarily reducing the dose or stopping the medication for a short period of time until the rash is under control before resuming the medication.
- How is it treated?
So, what should we do in this situation? Don't worry, doctors have come up with an effective coping plan:
(1) Prevention first:
- Moisturizers and sunscreen can be used before starting EGFR inhibitors
- Avoid harsh skincare products
- Keep your skin clean, but don't overdo it
(2) Mild rash:
- Topical antibiotic ointment (e.g., clindamycin, erythromycin)
- Use low-concentration topical steroid creams
- Continue to moisturize and protect from the sun
(3) Moderate rash:
- In addition to the above treatments, oral antibiotics (such as doxycycline) may be needed
- Consider using a medium-strength steroid cream
(4) Severe rash:
- Strong antibiotics taken by mouth may be needed
- Treatment with systemic steroids
- Under the guidance of a dermatologist, some special medications, such as dapsone, may be used
It is worth mentioning that recent studies have found that dapsone is very effective in severe EGFR inhibitor-associated rashes. This gives new hope to patients who do not respond well to conventional treatments.
- Life Tips:
In addition to medical measures, patients can pay attention to the following in their daily lives:
- Use a gentle, soap-free cleanser to cleanse your skin
- Choose moisturizers that don't contain oil
- Try to wear loose, breathable clothing
- Avoid prolonged exposure to the sun and protect yourself from the sun when you go outside
- Maintain a good frame of mind, as stress may also worsen the rash
- epilogue
Dear readers and friends, through today's introduction, I believe you have a deeper understanding of acne-like rashes caused by EGFR inhibitors. While this side effect may seem scary, keep in mind that:
- This is a common and manageable side effect
- The presence of a rash may mean that medication is working better
- In most cases, discontinuation of the drug is not required and can be controlled with appropriate treatment
Finally, I would like to emphasize that if you or your relatives and friends develop a rash after using EGFR inhibitors, it is important to tell the attending doctor in time and treat it under the guidance of the doctor. Do not stop taking the drug or treat it yourself, as this may affect the effectiveness of cancer treatment.
Remember, on the road to fighting cancer, we need to focus not only on the efficacy, but also on the quality of life. By managing side effects in the right way, we can make the path to treatment smoother.
May every cancer patient overcome the disease and regain their health! I also hope that this article will provide you with some useful information and assistance. If you still have any questions, please leave a message in the comment area and we will discuss and communicate together!
参考资料：Beshay A, Petersen M, Rhoads JLW. Severe EGFR inhibitor-induced acneiform eruption responding to dapsone. Dermatol Online J. 2021 Jul 15; 27(7). doi: 10.5070/D327754366. PMID: 34391331.