Preventing or treating anti-EGFR related skin rash with antibiotics?

Cutaneous folliculitis (a papulopustular acne-like skin rash), which is a common skin rash, is a dermatological phenomenon that is universally observed in the treatment of anti-epidermal growth factor receptor inhibitors in solid tumours (either tyrosine kinase inhibitors or monoclonal antibodies). Its appearance is quite common (about 60–80% of patients treated), is usually of a low or moderate grade (G1–2) and is typically associated with facial disfigurement and cutaneous adnexa changes (hair and eyelash alterations, ungueal infections, skin pruritus, xerosis, skin pigmentation, and bacterial suprainfection in rare cases). Severe cutaneous adverse events lead to psychological distress, and quality of life is probably impaired in these patients. The rash is generally mild to moderate, but of a high grade (G3/4) in 5% to 20% of patients. The typical papulopustular rash occurs within 1 to 3 weeks of starting treatment, and is fully developed at weeks 3 to 5. Usually, these skin toxicities are treated with both topical (moisturizers, emollients, topical antibiotics/steroids) and/or systemic measures (oral antibiotics, steroids and antihistaminic drugs). General recommendations suggest the use of topical agents for G1 events, with both topical and systemic treatment proposed for more severe grades. Appropriate preemptive measures are strongly recommended before and during treatment with anti-EGFR agents in the cancer setting.