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. 2020 Feb 4;130(3):1090–1092. doi: 10.1172/JCI133787

Figure 1. A model for folliculocentric pustular drug eruption.

Figure 1

(A) EGFR signaling is critical to hair follicle development and maintenance (EGF dependency). MEK and ERK1/2 signaling promotes degradation of transcription factor Krüppel-like factor 4 (KLF4). (B) During treatment with EGFR or MEK inhibitors, KLF4 accumulates and binds the IL36G promoter in cooperation with NF-κB activated by Cutibacterium acnes (C. acnes) via TLR2 to drive IL-36γ expression. This in turn promotes IL-8 expression and consequent neutrophil recruitment and presents as a folliculocentric pustular drug eruption.