Rare case of acquired perforating dermatosis induced by cetuximab

Natalizumab‐induced acquired perforating dermatosis

“…Our patient uniquely extends this time window to 5 years, and over an 11‐month period from initial presentation, the rash evolved to look clinically and pathologically like APD. Histologically, APD induced by biologic therapy features perforation of collagen alone, in contrast to our case, which showed perforation of both collagen and elastic fibres 1–3 . As it is such a rare entity, there is no clear answer as to whether there are any clinical or pathological differences between biologic‐induced APD and other drug‐induced APD.…”

“…The mechanism by which these monoclonal antibodies contribute to a perforating dermatosis is unknown. Medication‐associated APD is most commonly found in men aged > 50 years, 1,3 with the development of this skin condition typically within 2–6 months of treatment onset 1–3 . Our patient uniquely extends this time window to 5 years, and over an 11‐month period from initial presentation, the rash evolved to look clinically and pathologically like APD.…”

“…To date, there has been only one other report of natalizumab‐induced APD 1 . APD has been reported in association with other biologics, namely infliximab, etanercept and cetuximab, 2,3 which have a variety of therapeutic targets. The mechanism by which these monoclonal antibodies contribute to a perforating dermatosis is unknown.…”

Acquired perforating dermatosis induced by necitumumab

“…Three reported APD cases that were induced by other EGFRi agents (cetuximab, panitumumab and gefitinib) corroborate our claim. 2,4,5 Although the partial loss of epithelia and the exposure of dermal material caused by rubbing is known to trigger APD, 7 neither pruritus nor chronic rubbing was observed in the present case, which may suggest that there were other precipitating factors of APD. Curiously, Elastica Masson staining revealed that the acneiform lesion displayed collagen fibre protrusion similar to that observed in the APD lesion (Fig.…”

“…2,3 Most APD cases are associated with systemic disorders such as diabetes or chronic kidney failure, and APD rarely occurs due to drug administration. 2,[4][5][6] We report the first case of necitumumab-induced APD.…”