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

Abstract

Nivolumab, a fully human IgG4 immune checkpoint modulator, binds to the programmed cell death 1 (PD‐1) receptor on T cells and blocks their inhibition. Thus, it increases the anticancer host immune response by allowing T cells to attack tumor cells. Although anti‐PD‐1 immunotherapy is typically well accepted, deregulation of immune tolerance caused by nivolumab may determine immune‐related adverse events, among which skin toxicities represent the most common. We report a case of severe new‐onset palmoplantar and nail psoriasis after receiving nivolumab treatment for metastatic melanoma.

European recommendations for management of immune checkpoint inhibitors‐derived dermatologic adverse events. The EADV task force ‘Dermatology for cancer patients’ position statement

“…Although not systemically investigated, they are characterised by a late time of onset, extended up to several months. In some cases, lesions may persist after drug ICI discontinuation 84 . A wide range of nail changes (Fig.…”

“…In some cases, lesions may persist after drug ICI discontinuation. 84 A wide range of nail changes (Fig. 7a-c) has been reported in association to ICI treatment: lunular erythema, onychorrhexis, thinning of the nail plate, fragility, longitudinal fissures, splitting in layers, onycholysis and onychomadesis.…”

“…40,41 De novo, histologically confirmed, nail psoriasis, presenting as nail thickening along with periungual erythema has been also seen with nivolumab. 84,86 If several nails are involved, or the nail lesions are not responding to topical therapy or are associated with skin involvement, systemic therapy should be discussed. In this context, oral retinoids (acitretin, alitretinoin) represent the first-line therapy.…”

Treatment of Advanced Melanoma: Past, Present and Future

“…More recently, Yano et al reported that HLA-DR15, which is reported to correlate with autoimmune disease via IL-17 regulation, could be a predictive marker for ICI-induced secondary adrenal insufficiency [ 78 ]. Since both IL-17 and sCD163 reportedly correlate with autoimmune skin diseases such as bullous pemphigoid [ 79 ], psoriasis [ 80 ] and alopecia areata [ 81 ], and these autoimmune skin diseases were occasionally induced by ICIs in melanoma patients [ 82 , 83 , 84 ], HLA genotyping before treatment may help to avoid the incidence of irAEs by ICIs.…”

A challenging acral psorasiform eruption in the setting of pembrolizumab therapy

“…We read with interest the case report in Dermatologic Therapy by Altobrando et al entitled severe de-novo palmoplantar and nail psoriasis complicating nivolumab treatment for metastatic melanoma. 2 We report a case illustrating how PD-1 inhibitors can complicate the clinical picture in the setting of malignancy. Histopathology can be helpful in distinguishing between these two diagnoses.…”