Efficacy of topical beta-blockers in the management of EGFR-inhibitor induced paronychia and pyogenic granuloma-like lesions: case series and review of the literature

Article Details

Authors
Pietro Sollena MD, Maria Mannino MD, Francesco Tassone MD, Maria Alessandra Calegari MD, Ettore D’Argento MD, Ketty Peris MD

Article Type
Review

DOI
10.7573/dic.212613

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Abstract

Nail toxicities, such as paronychia and pyogenic granuloma-like lesions, are well-recognized side effects of epidermal growth factor receptor inhibitor (EGFR-I) therapy that can significantly impair patient’s quality of life and compliance to anticancer treatment. Numerous therapeutic options are available, with variable rates of success. Recently, topical β-blockers have emerged as a novel, non-invasive treatment strategy. We tested the effectiveness of topical timolol 0.5% gel, twice daily, under occlusion for 30 days, on paronychia and periungual pyogenic granuloma-like lesions in 9 patients being treated with EGFR-I. We also reviewed the available literature on this topic, which is the use of topical β-blockers in the management of EGFR-I-induced nail toxicities. We assessed 25 lesions consistent with the diagnosis of EGFR-I-induced pyogenic granuloma-like lesions and paronychia (21 diagnosed as pyogenic granuloma-like, and four as paronychia). Thirteen of the 25 lesions achieved complete resolution, 9/25 reached at least improvement, and only 3/25 did not respond to the intervention. As for the review, four papers met the scope of our research. The results confirmed at least partial benefit in the majority of treated patients. Among current strategies, high-potency topical corticosteroids are a well-known treatment option especially for paronychia, targeting the inflammatory component of such lesions; nevertheless, the management of pyogenic granuloma-like lesion is often more complex and the success rate is variable. Nail plate avulsion and phenol chemical matricectomy are not highly effective and display some degree of invasiveness. Topical β-blockers seem to be promising alternatives, especially in fragile cancer patients who may be unsuitable candidates for an invasive procedure.

Keywords: epidermal growth factor, paronychia adverse event, pyogenic granuloma, topical beta-blockers.

Citation: Sollena P, Mannino M, Tassone F, Calegari MA, D’Argento E, Peris K. Efficacy of topical beta-blockers in the management of EGFR-inhibitor induced paronychia and pyogenic granulomalike lesions: case series and review of the literature. Drugs in Context 2019; 8: 212613. DOI: 10.7573/dic.212613

Contributions: All authors contributed equally to the preparation of this review. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at https://www.drugsincontext.com/wp-content/uploads/2019/10/dic.212613-COI.pdf

Acknowledgments: None.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2019 Sollena P, Mannino M, Tassone F, Calegari MA, D’Argento E, Peris K. https://doi.org/10.7573/dic.212613. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2019 Sollena P, Mannino M, Tassone F, Calegari MA, D’Argento E, Peris K. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/efficacy-of-topical-beta-blockers-in-the-management-of-egfr-inhibitor-induced-paronychia-and-pyogenic-granuloma-like-lesions:-case-series-and-review-of-the-literature/

Correspondence: Pietro Sollena, MD, Department of Dermatology, Catholic University of the Sacred Heart, Fondazione Policlinico A. Gemelli IRCCS, L.go Agostino Gemelli, 8 – 00168 Rome, Italy. pietrosollena@gmail.com; pietrosollena@virgilio.it

Provenance: invited; externally peer reviewed.

Submitted: 1 August 2019; Peer review comments to author: 13 September 2019; Revised manuscript received: 3 October 2019; Accepted: 4 October 2019; Publication date: 6 November 2019.

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