Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
Therapy Letters
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Observation Letters
87 (
); 548-551

Erlotinib-induced reactive perforating collagenosis in a case of lung adenocarcinoma

Dermatology and Plastic Surgery Center, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
Corresponding author: Dr. Fei Hao, No. 1, Shuanghu Branch Road, Yubei District, Chongqing 401120, China.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Jiang X, Song TT, Hao F. Erlotinib-induced reactive perforating collagenosis in a case of lung adenocarcinoma. Indian J Dermatol Venereol Leprol 2021;87:548-51.


Acquired reactive perforating collagenosis, an uncommon dermatosis characterized by transepidermal elimination of degenerated collagen, generally affects patients with diabetes mellitus, chronic renal insufficiency, Hodgkin’s lymphoma, acute leukemia, infestations like scabies, etc. Herein, we report a rare case induced by oral erlotinib in a woman with lung adenocarcinoma.

A 53-year-old female, previously diagnosed with lung adenocarcinoma (Stage III b) which was surgically resected two years back and later initiated on treatment with oral erlotinib 150 mg daily, presented to the dermatology clinic with skin eruptions. She had developed pruritic reddish papules over her face, neck and trunk one week after starting erlotinib and the lesions gradually progressed. Pruritic lesions were noted on the buttocks, perineum, trunk and extremities too, in the past two months. Physical examination revealed scattered or densely distributed reddish follicular papules and papulopustules involving the face, neck and upper trunk [Figure 1a]. Multiple red-colored, umbilicated, dome-shaped papules of size five to ten millimeters were noted on the trunk and extremities, a few of them partly coalescing to form plaques [Figures 1b and c]. Some lesions also exhibited a linear configuration, indicating a Koebner phenomenon. Histopathology from the umbilicated papule showed a cup-shaped depression of the epidermis with a keratin plug showing parakeratosis, inflammatory debris and degenerated collagen fibers and perivascular infiltrate of inflammatory cells below the depression [Figure 2a]. The elimination of degenerated collagens fibers through the epidermis could be seen [Figures 2b and c].

Figure 1a:: Reddish follicular papules, papulopustules on her face, neck and upper trunk
Figure 1b:: Multiple red-colored, dome-shaped papules on her trunk and extremities
Figure 1c:: Umbilicated papules with keratin plugs on her thighs. Koebner phenomenon can be seen
Figure 2a:: A cup-shaped depression of the epidermis containing a keratin plug (H and E, ×400)
Figure 2b:: Degenerated collagen fibers were eliminated through the epidermis (H and E, ×200) (arrows indicate the collagen fibers)
Figure 2c:: Degenerated collagen fibers were eliminated through the epidermis (Masson trichrome, ×200) (arrows indicate the collagens)

A diagnosis of acquired reactive perforating collagenosis with acneiform eruptions was made. She was treated with oral isotretinoin 10 mg twice daily, topical mometasone furoate cream 0.1% and tretinoin cream 0.1% once daily on her trunk and extremities. Most of the lesions regressed completely within two months [Figure 3]. One month later, erlotinib was discontinued following recovery from lung cancer. Isotretinoin and topical drugs were also stopped following that. No relapse was recorded during the 10-month follow-up period after treatment and a long-time follow-up is still being maintained.

Figure 3a:: Significant improvement in lesions on face and upper torso after 2-month therapy with oral isotretinoin
Figure 3b:: Significant improvement in lesions on waist, buttocks and upper thigh after 2-month therapy with oral isotretinoin
Figure 3c:: Significant improvement in thigh lesions after 2-month therapy with oral isotretinoin

Acquired reactive perforating collagenosis was originally described in 1967 by Delacrétaz et al., and mild superficial trauma and microangiopathy were thought to correlate with its development in genetically susceptible individuals.1 Drug-induced acquired reactive perforating collagenosis was occasionally reported with ranibizumab and sirolimus, but reasonable explanations were lacking.2,3 Erlotinib, the epidermal growth factor-receptor tyrosine kinase inhibitor, acts in the treatment of non-small-cell lung cancer by inhibiting the proliferation, adhesion, migration and apoptosis of epidermal growth factor-receptor-expressed tumor cells. Epidermal growth factor-receptor is also wildly expressed in the basal layer of the epidermis, outer root sheath of the hair follicles, sebaceous and sweat gland apparatus. m-TOR, the downstream effector of epidermal growth factor-receptor signaling, plays a pivotal role in acne onset which might explain why acneiform eruptions occur the earliest and is common in the settings of erlotinib administration.3-5 Given the actions of erlotinib, the inhibition of epidermal growth factor-receptor signaling might disturb the differentiation of keratinocytes, thus causing disruption of epidermis and follicular epithelium, contributing to the longer perforating process related to acquired reactive perforating collagenosis. Therefore, acneiform eruptions and acquired reactive perforating collagenosis may be taken together as two different stages of pathological changes in the skin induced by erlotinib, and a good response to systemic retinoids also corroborates the diagnosis, as in the present case. Acquired reactive perforating collagenosis following the occurrence of acneiform eruptions during erlotinib administration in lung adenocarcinoma is unusual and important for the dermatologists to recognize, in patients with epidermal growth factor-receptor inhibitor treatment.


We are deeply grateful to Mr. Chen Bang-tao for his help on writing.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


  1. , , , . Acquired reactive perforating collagenosis: Current status. J Dermatol. 2010;37:585-92.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , , , . Acquired perforating collagenosis associated with ranibizumab injection and succesfully switched to aflibercept. GMS Ophthalmol Cases. 2018;8:Doc06.
    [Google Scholar]
  3. , , , , , . Sirolimus-induced inflammatory papules with acquired reactive perforating collagenosis. Dermatology. 2008;216:239-42.
    [CrossRef] [PubMed] [Google Scholar]
  4. , . Reactive perforating collagenosis during erlotinib therapy. Acta Derm Venereol. 2012;92:216-7.
    [CrossRef] [PubMed] [Google Scholar]
  5. , , . Acneiform rash during lung cancer therapy with erlotinib (Tarceva(®)) Postepy Dermatol Alergol. 2013;30:195-8.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views

PDF downloads
View/Download PDF
Download Citations
Show Sections