A case report of psoriasis flare following immunotherapy: Report of an important entity and literature review

Abstract

Immune checkpoint inhibitors, such as anti-cytotoxic T-lymphocyte–associated antigen-4 and anti-programmed death-1, are a type of cancer immunotherapy approved for late-stage malignancy treatment. However, such therapies often induce immune-related adverse events. During anti-programmed death-1 blockade therapy, the most commonly reported adverse effects are skin toxicities, such as psoriasis—a chronic immune-mediated inflammatory disorder affecting the skin. We present the clinical characteristics of flared psoriasis in one patient under anti-programmed death-1 therapy who was diagnosed with T2N2M0/IIIB squamous lung carcinoma with a history of psoriasis for the past 5 years, exacerbated after the first cycle of nivolumab. After the third cycle, the extensive skin plaques necessitated treatment cessation. Following the discontinuation of anti-programmed death-1 treatment, skin lesions were treated locally. Possibly, anti-programmed death-1 immunotherapy can trigger immune-mediated diseases, such as psoriasis. Physicians should be alert to immune-related adverse events. Continuation or permanent cessation of treatment depends on the severity and reversibility of immune-related adverse events.

Small plaque psoriasis re‐visited: A type of psoriasis mediated by a type‐I interferon pathway

“…Recent studies have demonstrated enhancement of IL‐36–mediated antitumor activities following administration of immune checkpoint inhibitors 40 . There are reports on the development of guttate‐like psoriatic lesions in patients under ICI therapy 11,13,14,41 . In our study, ICI‐induced small plaque psoriatic lesions revealed an immune‐phenotype with a higher expression of MXA, LL37 and IL‐36γ compared to chronic plaque psoriasis.…”

“…40 There are reports on the development of guttate-like psoriatic lesions in patients under ICI therapy. 11,13,14,41 In our study, ICI-induced small plaque psoriatic lesions revealed an immune-phenotype with a higher expression of MXA, LL37 and IL-36γ compared to chronic plaque psoriasis. It is possible that ICI therapy upregulates type-I IFN signalling, and the development of type-I IFN mediated psoriatic lesions that confer a small plaque phenotype in some patients.…”

Exacerbation of psoriasis following COVID ‐19 vaccination in a patient previously treated with PD ‐1 inhibitor

“…[3][4][5][6] Our patient had previously been treated with nivolumab, which is also known to trigger and exacerbate psoriasis; however, this medication was discontinued 3 months prior to this flare with some subsequent improvement in his psoriasis. 7 Furthermore, influenza vaccination during active immunotherapy treatment for cancer appears to result in higher rates of vaccine-mediated immunologic side effects. 8 Consequently, it is unknown if prior treatment with PD-1 inhibitor immunotherapy predisposed our patient to a vaccinemediated autoimmune disease flare.…”

Psoriasis Flare-Up in a Patient Treated With Docetaxel for Metastatic Prostate Cancer

“…Disease severity is divided into categories of mild to moderate and moderate to severe. Various severity scores are used clinically to assess disease severity, including the Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), Body Surface Area (BSA), and Physician Global Assessment Index (PGA) [12]. Mild to moderate psoriasis typically requires a combination of topical glucocorticoids, vitamin D analogs, and phototherapy, while moderate to severe psoriasis requires systemic treatment, which is traditionally immunomodulators such as methotrexate, cyclosporin A, and retinoids.…”