PRIDE Complex (Papulopustules and/or Paronychia, Regulatory Abnormalities of Hair Growth, Itching, Dryness Due to EGFR Inhibitors)

A 51-year-old woman with metastatic colonic adenocarcinoma on cetuximab (an epidermal growth factor receptor/EGFR inhibitor) presented for an itchy eruption on the chest (A). There were erythematous papules and few pustules on the chest, xerosis, swelling and erythema of nail folds of multiple toenails (B), roughening of scalp hair and elongation and excessive curling of eyelashes (C) (Figure 1A–C). She was diagnosed with PRIDE complex (Papulopustules/paronychia, Regulatory abnormalities of hair growth, Itching, Dryness due to EGFR inhibitors) a term coined by Lacouture & Lai [1]. Papulopustular rash (lacking comedones) is the most common skin toxicity of EGFR inhibitors (occurring in 56%–74% of patients), followed by xerosis (48%–52%), paronychia (39%–40%), pruritus (24%), and hair changes (13%) [2, 3]. The rash and xerosis appear between weeks 1 and 3 of treatment, with paronychia and hair changes occurring more variably but typically around 2–4 months [4]. It has been hypothesized that EGFR inhibition can result in pilosebaceous disorganization resulting in entry of sebum into dermis and subsequent inflammation [1]. Interestingly, the papulopustular eruption may be an important prognostic marker for response to EGFR therapy [5]. Importantly, PRIDE complex does not require cessation of the EGFR inhibitor. It can typically be managed with acne topicals, emollients, and nonsedating antihistamines [5]. Sweta Subhadarshani: managing the patient, obtaining the photos, editing, supervision. Brad Woodie: preparing original draft, editing. Taylor Griffifth: preparing original draft, editing. Andrew Bevins: managing the patient, editing, supervision. The authors have nothing to report. All patients in this manuscript have given written informed consent for participation in the study and the use of their deidentified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical Approval: not applicable. The authors declare no conflicts of interest. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.