Acne inversa-like lesions associated with the multi-kinase inhibitor sorafenib

Abstract

Conflict of interest: None declared. Sorafenib is a multikinase‐inhibitor, which inhibits the receptor Raf serine/threonine kinases that regulate the ubiquitous Raf/MEK/ERK pathway.1 Dysregulation and overactivation of this pathway is associated with the genesis of solid tumours.2 Sorafenib is also implicated in the inhibition of tumour angiogenesis and progression that is caused by overexpression of tyrosine kinase receptors, leading to aberrant signalling in the vascular endothelial growth factor receptor pathway. Sorafenib has been used successfully for treating advanced and metastatic renal clear‐cell carcinoma and hepatocellular carcinoma. The effect is dose‐dependent, and the therapeutic dose is 400 mg twice daily. The signalling pathways and/or receptors inhibited by this new drug are physiologically expressed in the skin and hair follicles, and this explains the fact that cutaneous toxicity is the main adverse event of this drug class.3 It has been estimated that 70–90% of patients receiving sorafenib experienced at least one cutaneous side effect. Hand–foot skin reactions are the most common event, occurring in about 48% of patients, followed by subungual splinter haemorrhage (60%), alopecia (26–27%), stomatitis (26%), erythematous eruption on the trunk (20%), and xerosis cutis and dermatitis‐like facial erythema (5%). Results from various studies suggest that the appearance of skin toxicity during treatment may indicate successful antitumor activity.4