Gefitinib
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Pyoderma gangrenosum (first report) and folliculitis: case report A 55-year-old man developed pyoderma gangrenosum and folliculitis during treatment with gefitinib for non-small cell lung cancer. The man started oral gefitinib [Iressa] 250 mg/day and, although he developed diarrhoea and nausea, he continued to receive gefitinib. Two weeks after gefitinib initiation, he developed cutaneous lesions on his face and scalp. Erythematous lesions, that were resistant to treatment with topical betamethasone valerate, developed on his upper extremities and trunk 1 month later. After 6 months of gefitinib therapy, he developed a nodule on his right thumb. On examination, he had scaly erythematous lesions on his cheeks and scalp, and follicular papules and pustules on his eyebrows and upper lip. On his trunk and upper extremities were erythematous lesions with follicular papules. The perinail region of his left thumb had erythematous lesions associated with erosion, and a vascular node that was dark reddish and 9 x 4 x 3mm in diameter. Exudates from this lesion were cultured and were positive for Staphylococcus aureus. The man began receiving symptomatic therapies such as topical corticosteroids and ketoconazole for the erythematous lesions on his face and scalp, topical and systemic antibacterials for his follicular lesions, and ethacridine for his right thumb. After 2 weeks, grouping of the papules and pustules on his upper lip resulted in folliculitis vulgaris-like lesions. Ten months after starting gefitinib (and 3 months after his first visit), gefitinib was temporarily discontinued for 1 month due to suspected pneumonia. Despite other lesions clearing, an erythematous lesion on his hypogastrium persisted. Three weeks after gefitinib was stopped, ulceration of an erythematous lesion on his hypogastrium occurred, subsequently forming a lesion that had a tendency towards central necrosis; the lesion had an indurated, raised border. Gefitinib therapy was resumed, but his dosage was reduced from a daily administration to every alternate 2 weeks. In the following month, his lesion disappeared. Author comment: "[Folliculitis]-like lesions should be considered as adverse reactions because the lesions subsided by reduced gefitinib dosing. Although the clinical course of the pyoderma gangrenosum-like lesion was not totally in accord with gefitinib administration, it is presumed, but not proven, that this lesion is also an adverse reaction since it disappeared within 1 month after gefitinib dose reduction." Sagara R, et al. Adverse reactions to gefitinib (Iressa Rm): revealing sycosis- and pyorderma gangrenosum-like lesions. International Journal of Dermatology 45: 801047740 1002-1003, No. 8, Aug 2006 - Japan
» Editorial comment: A search of AdisBase, Medline and the WHO Adverse Drug Reactions database did not reveal any previous case reports of pyoderma gangrenosum associated with gefitinib.
0114-9954/10/1125-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 28 Oct 2006 No. 1125
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