Pharmacy employees
Pharmacy employees
One of your essential duties in supporting cancer patients is to inform them about side effects, in particular folliculitis, so that it does not reach a severe grade with the patient’s quality of life deterioration and anti-cancer therapy interruption or definitive discontinuation.¹
What is Folliculitis?
Folliculitis is one of the skin toxicities related to anti-cancer treatment known as an acneiform rash. Folliculitis is a disorder characterized by inflammation or infection of the hair follicles. More specifically, it refers to skin inflammation characterized by follicular, papulopustular rashes, generally found on the face, scalp, upper chest, and back². Folliculitis is an expected adverse effect of some target therapies, EGFR inhibitors¹, and other tyrosine kinase inhibitors⁶.
This infection of the hair follicle should not be confused with acne. It is characterized by severe skin dryness and by the absence of lesions such as “comedones” and “micro cysts”, distinctive of acne¹.
Grade 1
Covering < 10 % of the body surface area; no intervention indicated.
Grade 2
Covering 10-30% of the body surface area; topical intervention initiated
Grade 3
>30% of the body surface area; systemic intervention indicated
In the first two weeks of cancer treatment, folliculitis may cause severe skin toxicity in some patients, which may have an unfavorable impact on the patient's quality of life¹⁴⁵. Acneiform rash develops in 75%-90% (all grades) and 10%-20% (grade 3) in patients within the first days to weeks after initiation of therapy⁶. Occurrence and severity of the rash have been positively correlated to therapy response with EGFR inhibitors⁶. It has been reported that (bacterial) colonization or superinfections of the rash develop in up to 38% of cases⁶.
Drugs that induce folliculitis¹⁴⁵
Folliculitis is most often observed with:
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EGFR inhibitor therapies strongly expressed in the sebaceous epithelium
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anti-HER² therapies
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mTOR inhibitors
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BRAF inhibitors
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MEK inhibitors
Management advice for your patient
Listening to your patient is essential: this will allow you to measure the severity of the skin toxicity and its effects on everyday life. The extent of this toxicity is not necessarily proportional to the extent of the lesions observed. You can also reassure your patient and their relatives that folliculitis is not contagious when it is not superinfected.
About prevention⁶
Behavioral aspects and skin care:
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Avoidance of frequent washings with hot water (hand washing, shower, baths)
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Avoidance of skin irritants, such as OTC anti-acne medications, solvents, or disinfectants
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Avoidance of excessive sun exposure
Therapeutic management of acneiform rash⁶:
For grade 1 and 2 rash, initiation or escalation of the potency of topical corticosteroids and initiation of oral tetracycline antibiotics for at least 6 weeks are recommended.
For the management of grade 3 rash, a short course of systemic corticosteroids is suggested along with interruption of EGFRis until the rash is grade 1.
According to the severity of this toxicity, the patient can be referred to a dermatologist or to the oncology team.
Recommended treatment
 Tolerance Extremely gentle cleanser |  Tolerance Control Skin recovery cream |  Tolerance Control Skin recovery balm |
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