EGFR Inhibitor-Induced Folliculitis Decalvans: A Case Series and Management Guidelines

This case series investigates three patients who developed folliculitis decalvans, a rare scarring alopecia, during afatinib therapy for cancer, highlighting the dermatological side effects of EGFR inhibitors. Patients aged 38 to 65 experienced scalp pruritus, erythema, and pustular lesions, with hair loss occurring after a median of 4 months. Diagnosis was confirmed via trichoscopy, and treatment with antibiotics like doxycycline and topical corticosteroids led to improvement. The study emphasizes early diagnosis and management to prevent irreversible hair loss. Management involves oral tetracyclines and topical treatments, with therapy lasting from 4 to 16 weeks or longer for persistent cases. Avoiding sun exposure is advised due to photosensitivity risks, and a proactive approach is crucial to maintain treatment compliance and avoid interruptions in anti-EGFR therapy.