Trichoscopic Findings of Erosive Pustular Dermatosis of the Scalp Associated with Gefitinib

A 57-year-old Japanese female developed scarring alopecia while undergoing treatment with gefitinib, an EGFR inhibitor, for non-small cell lung cancer. The alopecia was accompanied by a skin rash and scalp lesions resembling erosive pustular dermatosis. Trichoscopic examination revealed specific findings such as follicular keratotic plugging and hair shaft disorder. Histological analysis showed ruptured hair follicles with infiltration of immune cells. Treatment with oral minocycline and topical steroids was ineffective, but reducing the gefitinib dosage led to gradual improvement in alopecia, although scarring persisted. The study suggested that follicular keratotic plugging might be linked to scarring alopecia from EGFR inhibitor therapy.