Selumetinib‐Induced Acneiform Eruption: Systematic Review and Proposed Therapeutic Algorithm
Elisa Marzola, Federico Gianessi, Mattia Minghini, Edoardo Arlotti, Alessandro BorghiBackground
Selumetinib, a MEK1/2 inhibitor approved for symptomatic, inoperable plexiform neurofibromas in neurofibromatosis type 1, is frequently associated with skin adverse events, including acneiform eruptions.
Methods
A systematic review was conducted in accordance with PRISMA 2020 guidelines in order to explore selumetinib‐associated acneiform eruptions. A comprehensive literature search was performed in PubMed, Embase, and Scopus databases. Eligible studies included clinical trials, observational studies, and case reports/series. Two independent reviewers screened titles/abstracts and full texts. Data on patient characteristics, incidence, clinical features, and management were extracted and synthesized.
Results
Sixteen studies and an additional unpublished case from the Dermatology Unit of Ferrara, Italy, were included, with 248 cases of selumetinib‐associated acneiform eruption among 422 treated patients (58.8%). Lesions mainly involved the face and upper trunk, were typically papulopustular and monomorphic, and usually lacked comedones. Onset was generally early, often within 2 weeks. Management was heterogeneous, but topical agents and oral tetracyclines were the main treatments. Greater severity was associated with systemic antibiotic use. Selumetinib was maintained in most evaluable cases.
Conclusions
Acneiform eruption is a common and clinically relevant selumetinib toxicity. Early recognition and stepwise dermatologic management usually allow symptom control without treatment discontinuation.