治療EGFR抑制劑引起甲溝炎新利器──局部β-腎上腺素受體抑制劑

New Choice for Paronychia in Patients Treated with EGFR inhibitors- Topical Beta-Adrenergic Receptor Inhibitor

甲溝炎是使用表皮生長因子受體抑制劑（epidermal growth factor-receptor inhibitors；EGFRi）常見的不良反應，經常在治療4～8週後發生。症狀包括患部紅腫，指甲外側腫脹、壓痛，若發展成化膿性肉芽腫會感到劇烈疼痛。雖然不會有致命危險，但甲溝炎與化膿性肉芽腫高度影響病人日常的活動性，嚴重影響生活品質及對EGFRi治療的配合度。過去主要使用局部類固醇、局部或全身性抗生素、局部消炎藥、硝酸銀等方式治療。在近幾年的研究顯示，局部β-腎上腺素受體抑制劑用於EGFRi引起的甲溝炎和化膿性肉芽腫是有效且安全的，因此可做為臨床治療新的選擇。

Paronychia is a common adverse event caused by epidermal growth factor receptor inhibitors (EGFRi) that typically occurs in four to eight weeks after EGFRi treatment. The manifestations of paronychia are erythema, oedema, swelling, and tenderness of the lateral nail folds. When pyogenic granuloma develops on the nail fold, patients can experience severe pain. Despite non-life-threatening conditions, paronychia and pyogenic granuloma-like lesions are highly disabling for patients and may affect patients’quality of life with poor compliance with EGFRi. Paronychia can be treated with topical steroids, topical or systemic antibiotics, topical anti-inflammatory agents, and silver nitrate, etc. Recently, several studies demonstrated that topicalβ-adrenergic receptor inhibitors can be effectively and safely applied to EGFRi-related paronychia and pyogenic granuloma. Therefore,β-adrenergic receptor inhibitors are potentially a new therapeutic choice for EGFRi-related paronychia.