Papulopustular Rash Management


A common skin side associated with EGFR inhibitors drugs, such as cetuximab (Erbitux) and erlotinib (Tarceva), include a papulopustular rash which has often been misdiagnosed as acne.  This rash occurs mostly on the face and chest – areas in which estheticians work on constantly.

Epidermal growth factor receptors (EGFR) are transmembrane tyrosine kinase receptors that have an important role in the maintenance of the normal physiology of skin.  The activation of EGFR is an essential step in the proliferation, differentiation, and survival of keratinocytes. The rash usually manifests as itch, red papules and pustules. Parts of the skin containing higher densities of sebaceous glands, such as the scalp and face (particularly the nose, cheeks, and around the mouth), tend to be more susceptible to this rash.


What is the cause of the papulopustular rash in your client?

This rash is likely caused by the direct inhibition of EGFR in epithelial cells. The inhibition of EGFR in epithelial cells disturbs the normal function of keratinocytes, leading to increased production of chemokines that recruit inflammatory cells, such as leukocytes and neutrophils, and resulting in an inflammatory response that manifests as a papulopustular rash.

Determine any medications; contraindications and cautions before proceeding with any spa treatment.

Treatments that can be offered:

  • Airbrush and/or camouflage makeup can be done to cover up rash as this affects the client psychologically.
  • Extractions can be done once permission granted from the client’s Physician.
  • Soothing, calming facial (modified for this rash)
  • Laser

DISCLAIMER: Work within the scope of your license/certification.

Portrait of Mórag Currin. About the Author

Mórag Currin is a highly sought-after esthetic educator with more than 27 years of spa industry experience and more than twelve years of training and training management experience. She travels around the globe with her training and expertise, helping to raise the bar in the spa industry and to open the door to all people, regardless of skin type or health condition. To learn more about this topic and many other skin challenges, diseases, and symptoms, check out Mórag’s book, Health Challenged Skin: The Estheticians’ Desk Reference.

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