Alopecia Refractory Case Study

INTRODUCTION
Both scarring and nonscarring alopecias have been described with long-term use of epidermal growth factor receptor (EGFR) inhibitors. Current treatments revolve around anti-inflammatory agents such as topical corticosteroid ointments, creams, and intralesional injections to reduce follicular inflammation. Unfortunately, none of these therapies are universally effective. Here, we describe a case of erlotinib-induced alopecia refractory to intralesional and topical corticosteroids that was successfully treated with doxycycline as a novel treatment approach for EGFR inhibitoreassociated alopecia. CASE REPORT
A 77-year-old woman with a 4-year history of nonesmall cell lung cancer (NSCLC) was started on the EGFR inhibitor, erlotinib (initial dose of
She experienced the early papulopustular eruption on her face and chest within 2 weeks after initiating erlotinib therapy, which resolved after a month of minocycline and dose reduction of her erlotinib to 100 mg daily, but otherwise she tolerated erlotinib without further dermatologic concerns. However, 5 months after initiating erlotinib, localized asymptomatic alopecia developed over her right parietal scalp. Physical examination found a 5- x 3-cm area of alopecia with peripheral crusting and scale that was clinically consistent with an erosive pustular form of EGFR inhibitoreassociated alopecia.
After her diagnosis, the patient received multiple therapies including bimonthly intralesional triamcinolone injections, daily topical triamcinolone acetonide cream 0.1%, and daily topical clobetasol solution for 1 year, all of which were unsuccessful.
Her alopecia worsened despite treatment and spread to her left parietal scalp. At the peak of involvement, she exhibited an 8- x 8-cm area of hair loss with erythema, yellow crusting, and scale over her bilateral parietal scalp areas (Fig 1). ½F1
Because of her continued scalp