Sahadevan Geethanjali, Cm Divyashanthi, Sivamani Kalaimani
Dermatology, Jawaharlal Institute of Postgraduate Medical Education & Research, Karaikal, IND.
Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND.
Cureus. 2025 Jun 11;17(6):e85774. doi: 10.7759/cureus.85774. eCollection 2025 Jun.
Epidermal growth factor receptor (EGFR) inhibitors are essential for treating non-small cell lung cancer (NSCLC) with EGFR mutations, but they frequently cause cutaneous toxicities collectively referred to as papulopustules and/or paronychia, regulatory abnormalities of hair growth, itching, and dryness due to epidermal growth factor receptor inhibitors (PRIDE) syndrome. This case describes a 55-year-old male with advanced NSCLC who developed toe-predominant paronychia, a papulopustular rash localized to the trunk and limbs, and diarrhea four to eight weeks after initiating first-line therapy with dacomitinib. Notably, causality was evaluated using multiple validated tools - Naranjo, WHO-UMC, and Liverpool Causality Assessment Tool - all of which indicated a "probable" relationship. Importantly, these adverse effects were managed symptomatically without the need for discontinuation or dose reduction of dacomitinib. This case contributes to the literature by documenting an atypical anatomical distribution (toe-predominant), early onset, and successful continuation of therapy, highlighting the importance of early recognition, pharmacologic assessment, and adverse event reporting to optimize the safety of EGFR inhibitors in clinical practice.
表皮生长因子受体（EGFR）抑制剂对于治疗具有EGFR突变的非小细胞肺癌（NSCLC）至关重要，但它们经常引起统称为丘疹脓疱和/或甲沟炎、由于表皮生长因子受体抑制剂导致的毛发增长调节异常、瘙痒和干燥的皮肤毒性（PRIDE综合征）。本病例描述了一名55岁的晚期NSCLC男性患者，在开始使用达可替尼进行一线治疗后的4至8周出现了以脚趾为主的甲沟炎、局限于躯干和四肢的丘疹脓疱性皮疹以及腹泻。值得注意的是，使用多种经过验证的工具——纳伦霍、世界卫生组织药物不良反应协作中心（WHO-UMC）和利物浦因果关系评估工具——对因果关系进行了评估，所有这些工具均表明存在“可能”的关系。重要的是，这些不良反应通过对症处理得到了控制，无需停用或减少达可替尼的剂量。本病例通过记录非典型的解剖分布（以脚趾为主）、早期发病以及治疗的成功持续，为文献做出了贡献，强调了早期识别、药物评估和不良事件报告对于优化临床实践中EGFR抑制剂安全性的重要性。
