Table 5.

Management of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors Induced Acneiform Rash (Reactive Treatment)⁷⁷

Grade	Treatment of Rash	TKI Treatment
1	Topical anti-inflammatory antibiotics 1% Clindamycin BID. Topical steroids like 2.5% hydrocortisone is considered, especially if the rash is itchy.	Continue treatment at the current dose and monitor for bacterial super-infection or worsening of the rash.
2	Oral anti-inflammatory antibiotics like Minocycline 100 mg daily or Doxycycline 100 mg BID with topical steroid cream (hydrocortisone 2.5%, desonide, alclometasone 0.05% to the face and neck or fluocinonide 0.05% cream to chest and back)	Continue treatment at the current dose and monitor for bacterial super-infection or worsening of the rash.
≥3	Dermatology referral. Oral prednisone (0.5 mg/kg/day X 5 days) in addition to oral anti-inflammatory antibiotics like minocycline 100 mg daily or doxycycline 100 mg BID with topical steroid cream. Low dose isotretinoin (20 to 30 mg/day) is also considered.	Interrupt the treatment. Restart the TKI at a reduced dose once the rash is ≤ 2. Discontinue the TKI, if the rash does not improve.

Abbreviation: TKI, tyrosine kinase inhibitors.