Papulopustular eruptions associated with EGFR-pathway-related targeted therapies: clinical spectrum, evidence boundaries, folliculocentric inflammation, and management considerations

Papulopustular eruptions are a common dermatologic side effect of EGFR inhibitors, distinct from acne vulgaris, and are better described as therapy-associated folliculocentric inflammatory eruptions. This review examines these eruptions in the context of classical EGFR inhibitors, MEK inhibitors, and amivantamab, highlighting differences in pharmacology and clinical behavior. The mechanisms involve KLF4/IL-36γ signaling and Cutibacterium acnes-related inflammation, with potential links to hair-follicle immune dysregulation and JAK-associated signaling. Management strategies are discussed, differentiating between guideline-supported care and approaches for more severe cases.