Grading of Severe Follicular Rash in Patients Receiving EGFR Inhibitors

(2) Extension of dermatitis by using ‘‘the rule of nines,’’ which considers: head = 9% (front and back), chest = 18%, back = 18%, right arm = 9%, left arm 9%, perineum = 1%, right leg = 18%, left leg = 18%. Since the body areas more often involved by follicular dermatitis reaction are the head, chest, and back, we classify the reaction as severe when the dermatitis involves more than 45% of the body and the type of lesion is papules, pustules, and plaques often covered by scales. It is important for dermatologists and oncologists to recognize this severe reaction and classify it in a uniform way in order to treat it properly. We believe that recognizing severe follicular rash may be useful to control signs and symptoms of skin toxicity in order to prevent therapy interruption, and also that it might be useful to understand treatment efficacy and mostly to improve patient quality of life.