51536 Erosive Pustular Dermatosis-like Eruption of the Scalp Secondary to Amivantamab

Amivantamab is a bispecific monoclonal antibody that targets epidermal growth factor receptor (EGFR) and mesenchymal-epithelial transition proto-oncogene.1 Early studies report acneiform rash and paronychia as the most common cutaneous adverse events.1-2 Here, we present the first three reported cases of patients who developed painful, crusted erosions, superficial ulcerations on the scalp, and alopecia with onset ranging from weeks to months on amivantamab, consistent with an erosive pustular dermatosis (EPD)-like eruption. None of the patients had a history of radiation, trauma, or actinic damage to the scalp, or other risk factors associated with EPD.3 All patients had a preceding prodromal acneiform eruption and paronychia, followed by a disordered hypergranulation or ulcerations at additional sites. They all required interruption of their anticancer therapy and were treated with multiple rounds of oral antibiotics, steroids, and retinoids with poor response. Two patients required permanent discontinuation of amivantamab due to severe skin toxicity and progression of disease, with eventual resolution of their symptoms. Interestingly, one patient was able to continue amivantamab therapy with the initiation of low-dose dapsone, which has been shown to be effective in the management of other refractory or severe EGFR inhibitor-associated toxicities.4-6 Delay in diagnosis of EPD-like eruption due to its resemblance to other dermatological disorders can lead to increased morbidity and significant psychosocial implications. Given the severity and abrupt nature of the eruption, it is important for dermatologists to have a high clinical suspicion of EPD-like eruptions with amivantamab use to facilitate prompt treatment.