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Rare case of acquired perforating dermatosis induced by cetuximab

Dear Editor, A 56-year-old Japanese woman was referred due to suspected drug eruptions. She had been treated with paclitaxel and cetuximab for spindle cell carcinoma of the left tongue 1 month before. No other contributory past medical history, including diabetes mellitus and chronic renal disease, was noted. For the treatment of spindle cell carcinoma of the left tongue, an operation was first performed, followed by adjuvant chemoradiotherapy with cisplatin. The chemotherapy was switched to nivolumab because of metastasis in the residual tongue and lung. After four administrations of nivolumab therapy, computed tomography revealed progressive disease and the chemotherapy was changed to paclitaxel and cetuximab. After three administrations of weekly paclitaxel–cetuximab therapy, cutaneous eruptions with strong pruritus appeared on the face, which spread to the four extremities. Physical examination during her first visit to us showed 2–3-mm round to oval erythematous keratotic papules and nodules with centered yellow to black crusts on the face and distal four extremities (Fig. 1a–c), some of which were in a linear distribution (Fig. 1b).