A distinct cutaneous reaction to sorafenib and a multikinase inhibitor

A 52-year-old male with metastatic renal cancer developed a painful papulopustular eruption on his face, scalp, and neck, along with alopecia, after starting treatment with sorafenib, a multikinase inhibitor. The patient also experienced painful bullous lesions on his palms and soles, and a "sandpaper-like" texture to his skin. Biopsy revealed comedone-like follicular dilatation and squamous metaplasia. The skin condition improved with oral tetracycline and topical treatments, but recurred upon resuming sorafenib. This case highlighted a unique sorafenib-induced cutaneous reaction not previously described, implicating the drug as the cause.