When bugs and drugs conspire: driving acneiform skin toxicity

J Clin Invest. 2020 Mar 2;130(3):1090-1092. doi: 10.1172/JCI133787.

Abstract

Therapy with antineoplastic agents that inhibit EGFR and MEK is frequently limited by cutaneous adverse reactions, most commonly acne-like eruptions. In this issue of the JCI, Satoh et al. define a mechanism for acneiform skin toxicity wherein EGFR/MEK inhibitors cooperate with the skin commensal Cutibacterium acnes to induce IL-36γ in keratinocytes via the combined actions of Krüppel-like factor 4 and NF-κB transcription factors at the IL-36γ promoter, resulting in neutrophil recruitment. In addition to elucidating why EGFR/MEK inhibitor-induced rashes are often pustular and folliculocentric, this mechanism provides justification for the long-standing practice of management with antibiotic therapy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Comment

MeSH terms

  • Acneiform Eruptions* / drug therapy
  • Antineoplastic Agents* / therapeutic use
  • ErbB Receptors
  • Humans
  • Kruppel-Like Factor 4
  • Protein Kinase Inhibitors / therapeutic use
  • Skin Diseases*

Substances

  • Antineoplastic Agents
  • KLF4 protein, human
  • Kruppel-Like Factor 4
  • Protein Kinase Inhibitors
  • EGFR protein, human
  • ErbB Receptors