Tufted hair folliculitis in a woman treated with lapatinib for breast cancer

Conflict of interest: none declared. A 56‐year‐old woman had been treated for breast cancer with oral lapatinib for 3 months at a daily dose of 1250 mg as part of the TEACH (Tykerb Evaluation After Chemotherapy) trial.1 She reported painful palmar dermatitis and alopecia with scalp itching. She had experienced no symptoms during the first 3 months of lapatinib therapy, then alopecia and folliculitis appeared on the scalp, followed after 2 more months by pyogenic granulomas on the right thumb. Physical examination revealed a dry dermatitis mostly over the fingers and periungual area, with fissures on the palms, paronychia with striate onychodystrophy, and two pyogenic granuloma‐like lesions of the right thumb (Fig. 1). Scalp examination showed patches of alopecia with hair tufts on the paretotemporal regions and scanty hair density, with erythema and scaling of the skin. Dermoscopy showed follicular hyperkeratosis, multiple tufts of 4–6 hair shafts emerging from dilated follicular openings, and the surrounding skin was atrichous and glossy. Small, yellowish white keratinous structures (hair casts) were evident around the hair shaft (Fig. 2). A large number of short, club‐shaped roots with shaft depigmentation (telogen phase) were found in collected hair.