Treatment of epidermal growth factor receptor inhibitor-induced severe paronychia with pyogenic granuloma-like lesions with topical betaxolol: an open-label observation study

Chi Feng Yen, Chao Kai Hsu, Hsing San Yang, Chaw Ning Lee, Ching Chi Chi, Wen Hung Chung, Chih Liang Wang, Jong Hwei Su Pang, Chuang Wei Wang, Yu Shien Ko, Chun Wei Lu

Research output: Contribution to journalArticle

Abstract

Background: Paronychia is a common adverse event caused by epidermal growth factor receptor (EGFR) inhibitors. However, high rates of post-treatment discomfort, infection, recurrence, and increased time to return to work have been noted after nail plate avulsion for EGFR inhibitor-induced paronychia. Furthermore, poor wound healing and malnutrition were common conditions found in cancer patients. The aim of this study is to find an effective, pain-relieving, and noninvasive treatment for patients with severe paronychia induced by EGFR inhibitors. Methods: Data from a series of 35 non-small cell lung cancer cases suffering from EGFR inhibitor-induced paronychia with pyogenic granuloma-like lesions of digits treated with betaxolol 0.25% ophthalmic solution once daily were collected and analyzed. Results: Of the 35 patients suffering from grade 2 or 3 paronychia with pyogenic granuloma-like lesions induced by EGFR inhibitors, 34 (97.1%) demonstrated complete resolution and only one (2.9%) had partial resolution after 12 weeks of topical betaxolol treatment. The grading of paronychia according to the Common Terminology Criteria for Adverse Events decreased from an average of 2.29 to 0.63 after 4 weeks of treatment (P = 5.55 × 10−16). All the patients had significant improvement (50% pain reduction), as their pain visual analogue scale scores decreased from an average of 7.06 to 2.26 after one week of treatment (P = 6.11 × 10−25). Conclusion: Betaxolol 0.25% ophthalmic solution is an effective, safe, and pain-relieving treatment for patients suffering from EGFR inhibitor-induced paronychia with pyogenic granuloma-like lesions and deep fissures.

Original languageEnglish
Pages (from-to)326-332
Number of pages7
JournalInternational Journal of Dermatology
Volume59
Issue number3
DOIs
Publication statusAccepted/In press - 2019 Jan 1

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Paronychia
Betaxolol
Pyogenic Granuloma
Epidermal Growth Factor Receptor
Observation
Ophthalmic Solutions
Pain
Therapeutics
Return to Work
Pain Measurement
Nails
Terminology
Non-Small Cell Lung Carcinoma
Malnutrition
Wound Healing
Recurrence

All Science Journal Classification (ASJC) codes

  • Dermatology

Cite this

Yen, Chi Feng ; Hsu, Chao Kai ; Yang, Hsing San ; Lee, Chaw Ning ; Chi, Ching Chi ; Chung, Wen Hung ; Wang, Chih Liang ; Pang, Jong Hwei Su ; Wang, Chuang Wei ; Ko, Yu Shien ; Lu, Chun Wei. / Treatment of epidermal growth factor receptor inhibitor-induced severe paronychia with pyogenic granuloma-like lesions with topical betaxolol : an open-label observation study. In: International Journal of Dermatology. 2020 ; Vol. 59, No. 3. pp. 326-332.
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title = "Treatment of epidermal growth factor receptor inhibitor-induced severe paronychia with pyogenic granuloma-like lesions with topical betaxolol: an open-label observation study",
abstract = "Background: Paronychia is a common adverse event caused by epidermal growth factor receptor (EGFR) inhibitors. However, high rates of post-treatment discomfort, infection, recurrence, and increased time to return to work have been noted after nail plate avulsion for EGFR inhibitor-induced paronychia. Furthermore, poor wound healing and malnutrition were common conditions found in cancer patients. The aim of this study is to find an effective, pain-relieving, and noninvasive treatment for patients with severe paronychia induced by EGFR inhibitors. Methods: Data from a series of 35 non-small cell lung cancer cases suffering from EGFR inhibitor-induced paronychia with pyogenic granuloma-like lesions of digits treated with betaxolol 0.25{\%} ophthalmic solution once daily were collected and analyzed. Results: Of the 35 patients suffering from grade 2 or 3 paronychia with pyogenic granuloma-like lesions induced by EGFR inhibitors, 34 (97.1{\%}) demonstrated complete resolution and only one (2.9{\%}) had partial resolution after 12 weeks of topical betaxolol treatment. The grading of paronychia according to the Common Terminology Criteria for Adverse Events decreased from an average of 2.29 to 0.63 after 4 weeks of treatment (P = 5.55 × 10−16). All the patients had significant improvement (50{\%} pain reduction), as their pain visual analogue scale scores decreased from an average of 7.06 to 2.26 after one week of treatment (P = 6.11 × 10−25). Conclusion: Betaxolol 0.25{\%} ophthalmic solution is an effective, safe, and pain-relieving treatment for patients suffering from EGFR inhibitor-induced paronychia with pyogenic granuloma-like lesions and deep fissures.",
author = "Yen, {Chi Feng} and Hsu, {Chao Kai} and Yang, {Hsing San} and Lee, {Chaw Ning} and Chi, {Ching Chi} and Chung, {Wen Hung} and Wang, {Chih Liang} and Pang, {Jong Hwei Su} and Wang, {Chuang Wei} and Ko, {Yu Shien} and Lu, {Chun Wei}",
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Treatment of epidermal growth factor receptor inhibitor-induced severe paronychia with pyogenic granuloma-like lesions with topical betaxolol : an open-label observation study. / Yen, Chi Feng; Hsu, Chao Kai; Yang, Hsing San; Lee, Chaw Ning; Chi, Ching Chi; Chung, Wen Hung; Wang, Chih Liang; Pang, Jong Hwei Su; Wang, Chuang Wei; Ko, Yu Shien; Lu, Chun Wei.

In: International Journal of Dermatology, Vol. 59, No. 3, 01.03.2020, p. 326-332.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Treatment of epidermal growth factor receptor inhibitor-induced severe paronychia with pyogenic granuloma-like lesions with topical betaxolol

T2 - an open-label observation study

AU - Yen, Chi Feng

AU - Hsu, Chao Kai

AU - Yang, Hsing San

AU - Lee, Chaw Ning

AU - Chi, Ching Chi

AU - Chung, Wen Hung

AU - Wang, Chih Liang

AU - Pang, Jong Hwei Su

AU - Wang, Chuang Wei

AU - Ko, Yu Shien

AU - Lu, Chun Wei

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Paronychia is a common adverse event caused by epidermal growth factor receptor (EGFR) inhibitors. However, high rates of post-treatment discomfort, infection, recurrence, and increased time to return to work have been noted after nail plate avulsion for EGFR inhibitor-induced paronychia. Furthermore, poor wound healing and malnutrition were common conditions found in cancer patients. The aim of this study is to find an effective, pain-relieving, and noninvasive treatment for patients with severe paronychia induced by EGFR inhibitors. Methods: Data from a series of 35 non-small cell lung cancer cases suffering from EGFR inhibitor-induced paronychia with pyogenic granuloma-like lesions of digits treated with betaxolol 0.25% ophthalmic solution once daily were collected and analyzed. Results: Of the 35 patients suffering from grade 2 or 3 paronychia with pyogenic granuloma-like lesions induced by EGFR inhibitors, 34 (97.1%) demonstrated complete resolution and only one (2.9%) had partial resolution after 12 weeks of topical betaxolol treatment. The grading of paronychia according to the Common Terminology Criteria for Adverse Events decreased from an average of 2.29 to 0.63 after 4 weeks of treatment (P = 5.55 × 10−16). All the patients had significant improvement (50% pain reduction), as their pain visual analogue scale scores decreased from an average of 7.06 to 2.26 after one week of treatment (P = 6.11 × 10−25). Conclusion: Betaxolol 0.25% ophthalmic solution is an effective, safe, and pain-relieving treatment for patients suffering from EGFR inhibitor-induced paronychia with pyogenic granuloma-like lesions and deep fissures.

AB - Background: Paronychia is a common adverse event caused by epidermal growth factor receptor (EGFR) inhibitors. However, high rates of post-treatment discomfort, infection, recurrence, and increased time to return to work have been noted after nail plate avulsion for EGFR inhibitor-induced paronychia. Furthermore, poor wound healing and malnutrition were common conditions found in cancer patients. The aim of this study is to find an effective, pain-relieving, and noninvasive treatment for patients with severe paronychia induced by EGFR inhibitors. Methods: Data from a series of 35 non-small cell lung cancer cases suffering from EGFR inhibitor-induced paronychia with pyogenic granuloma-like lesions of digits treated with betaxolol 0.25% ophthalmic solution once daily were collected and analyzed. Results: Of the 35 patients suffering from grade 2 or 3 paronychia with pyogenic granuloma-like lesions induced by EGFR inhibitors, 34 (97.1%) demonstrated complete resolution and only one (2.9%) had partial resolution after 12 weeks of topical betaxolol treatment. The grading of paronychia according to the Common Terminology Criteria for Adverse Events decreased from an average of 2.29 to 0.63 after 4 weeks of treatment (P = 5.55 × 10−16). All the patients had significant improvement (50% pain reduction), as their pain visual analogue scale scores decreased from an average of 7.06 to 2.26 after one week of treatment (P = 6.11 × 10−25). Conclusion: Betaxolol 0.25% ophthalmic solution is an effective, safe, and pain-relieving treatment for patients suffering from EGFR inhibitor-induced paronychia with pyogenic granuloma-like lesions and deep fissures.

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