Psoriasis Vulgaris Exacerbation during Treatment with a PD-1 Checkpoint Inhibitor: Case Report and Literature Review

Abstract

Objective: The incidence of immune-related adverse events is growing as the use of checkpoint inhibitors is exponentially increasing. Cutaneous adverse events are among the most frequent immune-related adverse events. The purpose of this case report and literature review is to highlight psoriasis as a potential adverse event with need for early recognition. Case Report and Literature Review: We describe the case of a 65-year-old woman with psoriasis exacerbation while treated with nivolumab (anti-PD-1) for a stage IV melanoma. She had a history of scalp psoriasis but she presented with psoriatic lesions on both lower and upper limbs. Our patient was treated with topical steroids. So far, 34 other cases with an exacerbation of psoriasis during treatment with anti-PDL-1 or PD-1 therapy have been reported in the literature. A broad range of therapies are described, without any available guidelines for this particular condition. Conclusion: Psoriasis exacerbation is an established side effect of PD-1/PDL-1 checkpoint inhibitors with 35 reported cases. Early recognition and management are challenging as there are no clear guidelines available. A close collaboration between oncologist and dermatologist is mandatory to manage this immune-related adverse event.

Follicular psoriasis induced by pembrolizumab in a patient with advanced non‐small‐cell lung cancer

“…It is an uncommon disorder; a literature search results in mostly case reports, with some noting an association between pyoderma faciale and IBD. [1][2][3][4] This is the first reported case, to our knowledge, of pyoderma faciale occurring in the setting of SIBO.…”

“…In some cases, however, it is sufficient to stop the drug for a short time. 3 The mechanism of induction of psoriasis by pembrolizumab is still unclear, but it is probably due to the activation of Th17 lymphocytes, normally downregulated by PD1. 4 Follicular psoriasis (FP) is a rare entity that must be differentiated from other clinically similar diseases, especially keratosis pilaris.…”

Severe de‐novo palmoplantar and nail psoriasis complicating Nivolumab treatment for metastatic melanoma

“…In recent years more and more cases of psoriasis exacerbation and new‐onset psoriasis during anti‐PD1 therapy have been reported in the literature 6‐11 . Moreover, nail adverse events during targeted therapies for metastatic melanoma have been detailed 12 .…”

Ipilimumab/nivolumab‐induced pseudolymphoma in a patient with malignant melanoma

“…4,6 Uncommon reactions to checkpoint inhibitors recently described include lichenoid dermatitis, psoriasis, drug reaction with eosinophilia and systemic symptoms, neutrophilic dermatitis, sarcoidal inflammation, toxic epidermal necrolysis, immune bullous disorders, vitiligo, cutaneous lupus, vasculitis, and regression of nevi. [7][8][9][10][11][12] Pseudolymphomas can be broadly subdivided into a T-cell subtype or a B-cell subtype as well as further subsets, depending on the immunohistochemical analysis of the lymphocytes. 2 It is important to note that no specific feature is definitive of the diagnosis.…”