# Acneiform drug eruptions—update on pathophysiology and culprit drugs

**Authors:** Paul Ulrich, Konstantin Drexler, Mark Berneburg, Bernadett Kurz, Dennis Niebel

PMC · DOI: 10.3389/fmed.2026.1769362 · Frontiers in Medicine · 2026-02-23

## TL;DR

This paper reviews how certain medications can cause acne-like skin reactions and highlights the importance of managing these side effects without stopping essential treatments.

## Contribution

The paper provides an updated overview of the pathophysiology and drugs associated with acneiform adverse drug reactions.

## Key findings

- Acneiform ADRs often involve non-seborrheic body sites and can occur outside typical acne age ranges.
- Epidermal growth factor receptor inhibitors and janus kinase inhibitors are strongly linked to acneiform ADRs.
- Symptomatic treatment is often preferred over discontinuing essential medications.

## Abstract

Acneiform adverse drug reactions (ADRs) appear within weeks to months after the initiation of a new medication. As opposed to acne vulgaris, they typically present monomorphic inflammatory lesions, may involve atypical, non-seborrheic body sites and may arise outside the usual age range of any acne subtype. A wide range of drugs can trigger the eruption of acneiform ADRs with targeted therapies used in oncology (e.g., epidermal growth factor receptor inhibitors) carrying the highest risk. More recently, an increasing incidence of acneiform ADRs has been observed with the advent of januskinase inhibitors now being used in a wide range of inflammatory conditions. Many times, symptomatic treatment rather than discontinuation of the causative drug is feasible, particularly when the medication is essential for managing a serious underlying condition. Close cooperation between dermatologists and prescribing specialists is essential to manage cutaneous side effects enabling maintenance of the best available therapeutic regimen.

## Full-text entities

- **Genes:** KDR (kinase insert domain receptor) [NCBI Gene 3791] {aka CD309, FLK1, VEGFR, VEGFR2}, MAPK1 (mitogen-activated protein kinase 1) [NCBI Gene 5594] {aka ERK, ERK-2, ERK2, ERT1, MAPK2, NS13}, TLR2 (toll like receptor 2) [NCBI Gene 7097] {aka CD282, TIL4}, SRC (SRC proto-oncogene, non-receptor tyrosine kinase) [NCBI Gene 6714] {aka ASV, SRC1, THC6, c-SRC, p60-Src}, CTLA4 (cytotoxic T-lymphocyte associated protein 4) [NCBI Gene 1493] {aka ALPS5, CD, CD152, CELIAC3, CTLA-4, GRD4}, MTOR (mechanistic target of rapamycin kinase) [NCBI Gene 2475] {aka FRAP, FRAP1, FRAP2, RAFT1, RAPT1, SKS}, ITK (IL2 inducible T cell kinase) [NCBI Gene 3702] {aka EMT, LPFS1, LYK, PSCTK2}, JAK3 (Janus kinase 3) [NCBI Gene 3718] {aka JAK-3, JAK3_HUMAN, JAKL, L-JAK, LJAK}, TNF (tumor necrosis factor) [NCBI Gene 7124] {aka DIF, IMD127, TNF-alpha, TNFA, TNFSF2, TNLG1F}, JAK1 (Janus kinase 1) [NCBI Gene 3716] {aka AIIDE, JAK1A, JAK1B, JTK3}, PDCD1 (programmed cell death 1) [NCBI Gene 5133] {aka ADMIO4, AIMTBS, CD279, PD-1, PD1, SLEB2}, KLF4 (KLF transcription factor 4) [NCBI Gene 9314] {aka EZF, GKLF}, KIT (KIT proto-oncogene, receptor tyrosine kinase) [NCBI Gene 3815] {aka C-Kit, CD117, MASTC, PBT, SCFR}, TXK (TXK tyrosine kinase) [NCBI Gene 7294] {aka BTKL, PSCTK5, PTK4, RLK, TKL}, NFKB1 (nuclear factor kappa B subunit 1) [NCBI Gene 4790] {aka CVID12, EBP-1, KBF1, NF-kB, NF-kB1, NF-kappa-B1}, CXCL8 (C-X-C motif chemokine ligand 8) [NCBI Gene 3576] {aka GCP-1, GCP1, IL8, LECT, LUCT, LYNAP}, EGFR (epidermal growth factor receptor) [NCBI Gene 1956] {aka ERBB, ERBB1, ERRP, HER1, NISBD2, NNCIS}, ERBB2 (erb-b2 receptor tyrosine kinase 2) [NCBI Gene 2064] {aka CD340, HER-2, HER-2/neu, HER2, MLN 19, MLN-19}, CFTR (CF transmembrane conductance regulator) [NCBI Gene 1080] {aka ABC35, ABCC7, CF, CFTR/MRP, MRP7, TNR-CFTR}, IL36G (interleukin 36 gamma) [NCBI Gene 56300] {aka IL-1F9, IL-1H1, IL-1RP2, IL1E, IL1F9, IL1H1}, MAP2K7 (mitogen-activated protein kinase kinase 7) [NCBI Gene 5609] {aka JNKK2, MAPKK7, MEK, MEK 7, MKK7, PRKMK7}, BTK (Bruton tyrosine kinase) [NCBI Gene 695] {aka AGMX1, AT, ATK, BPK, IGHD3, IMD1}, TYK2 (tyrosine kinase 2) [NCBI Gene 7297] {aka IMD35, JTK1}, BRAF (B-Raf proto-oncogene, serine/threonine kinase) [NCBI Gene 673] {aka B-RAF1, B-raf, BRAF-1, BRAF1, NS7, RAFB1}
- **Diseases:** abscess (MESH:D000038), acneiform inflammation (MESH:D007249), telangiectasia (MESH:D013684), GIST (MESH:D046152), lichenoid (MESH:D017512), granulomatous (MESH:D013968), neutrophilia (MESH:C563010), pancreatic cancer (MESH:D010190), PRIDE syndrome (MESH:D013577), dermatoses (MESH:D012871), lupus pernio (MESH:D002647), Rosacea (MESH:D012393), colorectal cancer (MESH:D015179), infection (MESH:D007239), DHS (MESH:C566369), AGEP (MESH:D056150), drug eruption (MESH:D003875), lung cancer (MESH:D008175), Acneiform drug eruptions (MESH:D017486), DRESS (MESH:D063926), Crohn's disease (MESH:D003424), cancer (MESH:D009369), Cutaneous sarcoidosis (MESH:D012507), rupture (MESH:D012421), ADRs (MESH:D064420), perioral dermatitis (MESH:D019557), Eosinophilic folliculitis (MESH:C535953), head and neck cancer (MESH:D006258), erosions (MESH:D014077), eosinophilia (MESH:D004802), Chronic discoid CLE (MESH:D008179), edema (MESH:D004487), dryness (MESH:D014987), exanthema (MESH:D005076), nodulocystic lesions (MESH:D009059), folliculitis (MESH:D005499), erythematous papules (MESH:D000169), allergy (MESH:D004342), confusion (MESH:D003221), inflammatory facial dermatoses (MESH:D005148), malar rash (MESH:C000721270), desquamation (MESH:D017490), pustular dermatosis (MESH:D012872), human immunodeficiency virus infection (MESH:D015658), paronychia (MESH:D010304), necrotic (MESH:D009336), glands (MESH:D000307), erythema (MESH:D004890), CLE (MESH:D008178), fever (MESH:D005334), Acne (MESH:D000152), Flares of (MESH:D000067251), facial hyperplasia of (MESH:D006965), itching (MESH:D011537), SCAR (MESH:D013262), SCARs (MESH:D045169)
- **Chemicals:** doxycycline (MESH:D004318), BTK inhibitors (-), tretinoin (MESH:D014212), isoniazid (MESH:D007538), deucravacitinib (MESH:C000628674), Macrolides (MESH:D018942), trifarotene (MESH:C000629420), cetuximab (MESH:D000068818), rifampicin (MESH:D012293), propranolol (MESH:D011433), fatty acid (MESH:D005227), beta-lactam antibiotics (MESH:D008997), azelaic acid (MESH:C010038), prednisone (MESH:D011241), clindamycin (MESH:D002981), benzoyl peroxide (MESH:D001585), isotretinoin (MESH:D015474), lipid (MESH:D008055), minocycline (MESH:D008911), lithium (MESH:D008094), Imatinib (MESH:D000068877), tetracyclines (MESH:D013754), squalene (MESH:D013185), panitumumab (MESH:D000077544), retinoid (MESH:D012176), halogens (MESH:D006219), adapalene (MESH:D000068816), Infliximab (MESH:D000069285)
- **Species:** Cutibacterium acnes (species) [taxon 1747], Bacteria Latreille et al. 1825 (Bacteria stick insect, genus) [taxon 629395], Homo sapiens (human, species) [taxon 9606], Demodex (genus) [taxon 188544]

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## References

65 references — full list in the complete paper: https://tomesphere.com/paper/PMC12969058/full.md

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Source: https://tomesphere.com/paper/PMC12969058