Psoriasis and psoriasiform reactions secondary to immune checkpoint inhibitors

Cutroneo, Paola Maria; Ingrasciotta, Ylenia; Isgrò, Valentina; Rullo, Emmanuele Venanzi; Berretta, Massimiliano; Fiorica, Francesco; Trifirò, Gianluca; Guarneri, Claudio

doi:10.1111/dth.14830

Cited by 33 publications

(44 citation statements)

References 31 publications

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“…Dermatologic irAEs are seen in ~68% and 39% of patients treated with anti‐CTLA‐4 and anti‐PD‐1/anti‐PD‐L1 ICI therapies, respectively 3 . Recent analyses of ICI‐mediated psoriasis and psoriasiform irAEs estimated their incidence to be 3.8% of all skin toxicities, within which 7% of patients had pustular psoriasis and 2.6% developed erythroderma 15,17 . Psoriasiform irAEs are more common in men (~76%) aged 65 to 85 (66%), with nivolumab as the source in 66% to 69% of cases 15,17 .…”

Section: Discussionmentioning

confidence: 99%

“…There are also reports of ACH concomitant with PPP, 14 suggesting all three of these conditions fall along a spectrum of pustular psoriasis. Cases of ICI‐mediated pustular psoriasis have been reported, 15‐17 but remain rare within the literature. In addition, most cases of ICI‐mediated psoriasiform reactions are exacerbations or reactivation of pre‐existing disease 15,18 …”

Section: Introductionmentioning

confidence: 99%

“…Cases of ICI‐mediated pustular psoriasis have been reported, 15‐17 but remain rare within the literature. In addition, most cases of ICI‐mediated psoriasiform reactions are exacerbations or reactivation of pre‐existing disease 15,18 …”

Section: Introductionmentioning

confidence: 99%

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Severe de novo pustular psoriasiform immune‐related adverse event associated with nivolumab treatment for metastatic esophageal adenocarcinoma

et al. 2021

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Breakthrough targeted therapies have produced significant improvements in survival for cancer patients, but have a propensity to cause cutaneous immune‐related adverse events (irAEs). Psoriasiform irAEs, representing about 4% of dermatologic toxicities associated with immune checkpoint inhibitor (ICI) therapy, are usually mild, occur in older patients and present as an exacerbation of existing psoriasis after several doses of ICI therapy. We report a case of a 58‐year‐old woman with metastatic esophageal adenocarcinoma and no prior history of psoriasis who developed a pustular psoriasiform irAE, beginning 3 days after initiation of nivolumab and progressing to confluent erythroderma with pustules over 2 weeks despite topical steroid use. She had concurrent acrodermatitis enteropathica, clinically diagnosed and confirmed with a low serum zinc level, that improved with supplementation. Her psoriasiform irAE was refractory to systemic steroids and acitretin, prompting discontinuation of nivolumab and treatment with ustekinumab and concomitant slow taper of acitretin and prednisone. Pustular psoriasiform irAE is a rare but severe dermatologic toxicity resulting from ICI therapy. Given the diverse morphologic types of cutaneous irAEs that can occur during ICI therapy, a clinical and histopathologic examination of dermatologic toxicities is critical to identify patients who may benefit from biologic therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Severe de novo pustular psoriasiform immune‐related adverse event associated with nivolumab treatment for metastatic esophageal adenocarcinoma

et al. 2021

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“…Cutaneous squamous cell carcinoma is the second most common type of skin cancer after basal cell carcinoma, and its frequency is rising [ 3 ]. Squamous cell biology is discussed in terms of genesis, immunobiology, metabolism, metastatic spread, and treatment, with a focus on prevention, diagnostics, and treatment [ 15 , 16 ]. Patients with nail unit SCC who had Mohs micrographic surgery for their cancer were studied to better understand the clinical features and diagnostic factors involved [ 16 ].…”

Section: Related Workmentioning

confidence: 99%

“…Squamous cell biology is discussed in terms of genesis, immunobiology, metabolism, metastatic spread, and treatment, with a focus on prevention, diagnostics, and treatment [ 15 , 16 ]. Patients with nail unit SCC who had Mohs micrographic surgery for their cancer were studied to better understand the clinical features and diagnostic factors involved [ 16 ]. Use the EudraVigilance reporting system to evaluate the incidence of psoriasis as a particular immune-related cutaneous adverse event linked to ICIs.…”

Section: Related Workmentioning

confidence: 99%

Clinical Treatment Study of Secondary Multiple Squamous Cell Carcinoma with Psoriasis Vulgaris

Han

Feng

2022

Journal of Oncology

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Dermatologic diseases are the fourth most frequent nonfatal common illness, yet they have a psychological, economical, and professional burden that is comparable to or larger than other chronic conditions. From a survey in China of 6 provinces, the overall prevalence of psoriasis with squamous cell carcinoma was 0.47%. According to the current investigation, the outburst of skin disease was not associated with gender, but mainly with the climate of the environment; that is, dry cold weather will more likely to induce psoriasis. Approximately 3% of people around the world have psoriasis, which is near the most common autoimmune skin disease in adults. By simple estimation, there are at least two hundred million psoriasis patients in the world. Therefore, it is not just a simple health problem in a country or a region but a serious global challenge. Of note, about half of the adult patients had been reported to be sick in their childhood and they mostly fell ill around 10 years old. Actinic keratosis is perhaps the most common, followed by squamous cell carcinoma and, to a lesser extent, acne vulgaris, psoriasis, and hidradenitis suppurativa, as well as dermatitis herpetiformis. 5-Fluorouracil (5-FU) 0.5 percent is used topically to treat actinic keratosis and squamous cell carcinoma with good outcomes, while it might cause significant toxicity in certain patients. Dapsone, a Valosin-containing protein, is a medication that is often used to treat inflammatory skin disorders like psoriatic arthritis, but it can occasionally cause hemolytic anemia. Furthermore, biologic medications for the treatment of moderate-to-severe psoriasis and multiple squamous cell carcinoma have proven to be successful and safe; nevertheless, a small percentage of patients do not react to biologic treatment in the long term or do not respond at all. Based on the data from the China Food and Drug Administration, the majority of chemical drugs are utilized as the topical formulations, while Chinese medicines are mainly delivered by an oral route, suggesting that the market for topical preparations of Chinese medicine to treat skin diseases like psoriasis is worth exploration. This large interindividual diversity in response could be caused by changes in genes that encode proteins implicated in the disease’s pathologic environment or the medication’s mechanism of action. Pharmacogenetics is the study of the association between genetic differences and medication response, which is valuable for identifying nonresponsive patients and those who are more likely to suffer toxicity as a result of treatment. This study highlights the pharmacogenetic recommendations for dermatology therapies that have the strongest evidence at this time, highlighting those that have been incorporated in clinical practice guides. Pharmacogenetic clinical guidelines for multiple squamous cell carcinoma and psoriasis vulgaris were found in this investigation. Here, for multiple squamous cell carcinoma trichohyalin-like 1 (TCHHL1), 5-fluorouracil (5-FU) 0.5% is recommended. Along with that dapsone, Valosin-containing protein can be recommended for treating the psoriasis vulgaris. We made some clinical trials over the two diseases, and from the result obtained, we hypothesize that the suggested drug may be a novel therapeutic target in treating the multiple squamous cell carcinoma with psoriasis vulgaris.

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Psoriasis Risk With Immune Checkpoint Inhibitors

To,

Lee,

Chen

et al. 2024

JAMA Dermatol

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ImportanceImmune checkpoint inhibitors (ICIs) are recognized as revolutionary cancer therapies but have raised concerns about immune-related adverse events, including the development of autoimmune diseases.ObjectiveTo evaluate the psoriasis risk associated with the use of ICIs in patients with cancer.Design, Setting, and ParticipantsThis nationwide cohort study with a target trial emulation design used data from the Taiwan National Health Insurance database and the Taiwan Cancer Registry. The participants included were patients who received antineoplastic medications for cancer at stages III and IV between January 1, 2019, and June 30, 2021. Data were analyzed from May 2023 to July 2024.ExposuresPatients treated with ICIs were classified as ICI users, while those who received chemotherapy or targeted therapies were categorized as non-ICI users.Main Outcome and MeasuresThe primary outcome was the incidence of psoriasis during the follow-up period. Stabilized inverse probability of treatment weighting (IPTW) was used to mitigate potential confounders. Cox and Fine-Gray hazard models were used to calculate hazard ratios (HRs) for psoriasis risk between groups.ResultsOf 135 230 patients who received antineoplastic medications (mean [SD] age, 62.94 [13.01] years; 45.1% female), 3188 patients were eligible for the ICI user group, while 132 042 patients were eligible for the non-ICI user group. ICI users experienced a higher incidence of psoriasis at 5.76 cases per 1000 person-years, compared to 1.44 cases in the non-ICI group. After adjusting for demographics and comorbidities, ICI users were found to have a 2-fold increase in the risk of developing psoriasis (IPTW-adjusted HR, 3.31; IPTW-adjusted subdistribution HR, 2.43). Both as-started design and on-treatment design showed consistent findings, and the results were consistent and robust across all follow-up intervals and all sensitivity analyses.Conclusions and RelevanceIn this cohort study, patients with cancer treated with ICIs faced an increased risk of psoriasis. Medical professionals should be aware of the potential adverse effects of immunotherapy to ensure optimal cancer care.

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Psoriasis and psoriasiform reactions secondary to immune checkpoint inhibitors

Cited by 33 publications

References 31 publications

Severe de novo pustular psoriasiform immune‐related adverse event associated with nivolumab treatment for metastatic esophageal adenocarcinoma

Severe de novo pustular psoriasiform immune‐related adverse event associated with nivolumab treatment for metastatic esophageal adenocarcinoma

Clinical Treatment Study of Secondary Multiple Squamous Cell Carcinoma with Psoriasis Vulgaris

Psoriasis Risk With Immune Checkpoint Inhibitors

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