Email this article A case of uremic pruritus and papulo-pustular rash associated with anti-EGFR therapy in a patient with rectal cancer and chronic kidney disease
- Authors: Michenko A.V.1,2,3,4, Kruglova L.S.1, Shatokhina E.A.1,2, Lvov A.N.1,2, Simenskaya E.M.1, Romanov D.V.3,5,6, Kononenko I.B.7, Snegovoy A.V.7
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Affiliations:
- Central State Medical Academy Department for Presidential Affairs of the Russian Federation
- Lomonosov Moscow State University, Medical Research and Educational Center
- International Institute of Psychosomatic Health
- Institute of Plastic Surgery and Cosmetology
- M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
- Mental Health Research Center of the Russian Academy of Medical Sciences
- N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology ― branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation
- Issue: Vol 26, No 4 (2023)
- Pages: 331-338
- Section: DERMATO-ONCOLOGY
- Submitted: 28.04.2023
- Accepted: 27.06.2023
- Published: 08.09.2023
- URL: https://rjsvd.com/1560-9588/article/view/340919
- DOI: https://doi.org/10.17816/dv340919
- ID: 340919
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Abstract
Uremic pruritus is a common symptom in chronic kidney disease and end-stage renal failure. In addition to physical discomfort uremic pruritus disrupts sleep, negatively affects the psycho-emotional state and quality of life. In this group of patients, the association of uremic pruritus with an increase in mortality due to any causes was demonstrated. At the same time, there are no standardized approaches to the treatment of uremic itching. There is also a special category of patients receiving antitumor therapy and developing dermatological adverse events, also potentially accompanied by itching.
This article presents a case of uremic pruritus in a patient with papulo-pustular cutaneous reaction (grade II on a Scale Common Terminology Criteria for Adverse Events, CTCAE v 5.0) to the epidermal growth factor (EGFR) inhibitor cetuximab in combination with leucovorin and 5-fluorouracil for rectal cancer. Treatment of uremic pruritus with small doses of gebapentin (300 mg/day) led to complete regression of pruritus. Papulo-pustular rashes completely regressed after recommended systemic and topical therapy according to the severity of rush (doxycycline 100 mg 2 times a day for 5 days, cream with neomycin, natamycin and hydrocortisone 3 times a day for 7 days). Pruritus was absent during the next 6 months of follow-up. Antitumor therapy was not interrupted due to acneiform rush, and following supportive topical therapy allowed to control severity of exacerbations which did not exceed I–II grade according to CTCAE v 5.0 and did not require the addition of systemic therapy.
Thus, therapy of uremic pruritus with gabapentin has shown was effective also in a patient with severe comorbid pathology. Supportive topical therapy consistent with the severity of papulo-pustular rash reduced the severity of exacerbations during following EGFR inhibitor therapy.
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About the authors
Anna V. Michenko
Central State Medical Academy Department for Presidential Affairs of the Russian Federation; Lomonosov Moscow State University, Medical Research and Educational Center; International Institute of Psychosomatic Health; Institute of Plastic Surgery and Cosmetology
Author for correspondence.
Email: amichenko@mail.ru
ORCID iD: 0000-0002-2985-5729
SPIN-code: 8375-4620
MD, Cand. Sci. (Med.), Assistant Professor
Russian Federation, Moscow; Moscow; Moscow; MoscowLarisa S. Kruglova
Central State Medical Academy Department for Presidential Affairs of the Russian Federation
Email: kruglovals@mail.ru
ORCID iD: 0000-0002-5044-5265
SPIN-code: 1107-4372
MD, Dr. Sci. (Med.), Professor
Russian Federation, MoscowEvgeniya A. Shatokhina
Central State Medical Academy Department for Presidential Affairs of the Russian Federation; Lomonosov Moscow State University, Medical Research and Educational Center
Email: e.a.shatokhina@gmail.com
ORCID iD: 0000-0002-0238-6563
SPIN-code: 3827-0100
MD, Dr. Sci. (Med.), Professor
Russian Federation, Moscow; MoscowAndrey N. Lvov
Central State Medical Academy Department for Presidential Affairs of the Russian Federation;Lomonosov Moscow State University, Medical Research and Educational Center
Email: alvov@mail.ru
ORCID iD: 0000-0002-3875-4030
SPIN-code: 1053-3290
MD, Dr. Sci. (Med.), Professor, Senior Research Associate
Russian Federation, Moscow; MoscowEkaterina M. Simenskaya
Central State Medical Academy Department for Presidential Affairs of the Russian Federation
Email: skate779@mail.ru
ORCID iD: 0000-0002-1703-013X
SPIN-code: 2554-5354
Russian Federation, Moscow
Dmitry V. Romanov
International Institute of Psychosomatic Health; M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University); Mental Health Research Center of the Russian Academy of Medical Sciences
Email: newt777@mail.ru
ORCID iD: 0000-0002-1822-8973
SPIN-code: 2412-9077
MD, Dr. Sci. (Med.), Professor, Leading Researcher
Russian Federation, Moscow; Moscow; MoscowInessa B. Kononenko
N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology ― branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation
Email: Inessa.Kononenko@mail.ru
ORCID iD: 0000-0002-7142-2986
SPIN-code: 8306-1365
MD, Cand. Sci. (Med.)
Russian Federation, MoscowAnton V. Snegovoy
N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology ― branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation
Email: drsneg@gmail.com
ORCID iD: 0000-0002-0170-5681
SPIN-code: 8398-2396
MD, Dr. Sci. (Med.)
Russian Federation, MoscowReferences
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