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Combemale L, Bohelay G, Sitbon IY, Ahouach B, Alexandre M, Martin A, Pascal F, Soued I, Doan S, Morin F, Grootenboer-Mignot S, Caux F, Prost-Squarcioni C, Le Roux-Villet C. Lichen planus pemphigoides with predominant mucous membrane involvement: a series of 12 patients and a literature review. Front Immunol 2024; 15:1243566. [PMID: 38686381 PMCID: PMC11057232 DOI: 10.3389/fimmu.2024.1243566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/12/2024] [Indexed: 05/02/2024] Open
Abstract
Background Lichen planus pemphigoides (LPP), an association between lichen planus and bullous pemphigoid lesions, is a rare subepithelial autoimmune bullous disease. Mucous membrane involvement has been reported previously; however, it has never been specifically studied. Methods We report on 12 cases of LPP with predominant or exclusive mucous membrane involvement. The diagnosis of LPP was based on the presence of lichenoid infiltrates in histology and immune deposits in the basement membrane zone in direct immunofluorescence and/or immunoelectron microscopy. Our systematic review of the literature, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, highlights the clinical and immunological characteristics of LPP, with or without mucous membrane involvement. Results Corticosteroids are the most frequently used treatment, with better outcomes in LPP with skin involvement alone than in that with mucous membrane involvement. Our results suggest that immunomodulators represent an alternative first-line treatment for patients with predominant mucous membrane involvement.
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Affiliation(s)
- Loraine Combemale
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
- Dermatology Department, Saint Pierre-Brugmann and Queen Fabiola Children’s University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Gérôme Bohelay
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Ishaï-Yaacov Sitbon
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Btisseme Ahouach
- Pathology Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Marina Alexandre
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Antoine Martin
- Pathology Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Francis Pascal
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Isaac Soued
- Ear, Nose and Throat (ENT) Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Serge Doan
- Ophthalmology Department, Assistance Publique des Hôpitaux de Paris (APHP), Bichat Hospital, Paris University, Paris, France
| | - Florence Morin
- Immunology Department, Assistance Publique des Hôpitaux de Paris (APHP), Saint-Louis Hospital, Paris University, Paris, France
| | - Sabine Grootenboer-Mignot
- Immunology Department, Assistance Publique des Hôpitaux de Paris (APHP), Bichat Hospital, Paris University, Paris, France
| | - Frédéric Caux
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Catherine Prost-Squarcioni
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
- Pathology Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
- Histology Department, Sorbonne Paris Nord University, Bobigny, France
| | - Christelle Le Roux-Villet
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
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Wang S, Sun J, Deng S, Wu L, Li W, Ye T, Wu F, Wu Y, Zhou H. Lichen planus pemphigoides induced by anti-PD-1 antibody: A case only involved in oral mucosa with excellent topical treatment efficiency. J Cutan Pathol 2024; 51:114-118. [PMID: 37846754 DOI: 10.1111/cup.14547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023]
Abstract
Lichen planus pemphigoides (LPP) is a rare autoimmune subepidermal disease that can occur in patients receiving immune checkpoint inhibitors. Its clinical manifestations are combined with the characteristics of lichen planus with bullous pemphigoid that can occur on either skin or oral mucosa. It should be noted that oral LPP is very rare. Here, we report a novel case of oral LPP induced by an anti-PD-1 agent. The patient presented with typical clinical features in oral mucosa, and the diagnosis was based on histopathology and immunological studies. Given that the patient was receiving an anti-PD-1 agent, topical therapy was chosen, and a nice therapeutic effect was obtained. No significant recurrence was observed after a 2-year follow-up. A good and stable therapeutic effect achieved by rapid and local symptomatic medication suggests that accurate and sensitive diagnosis is necessary.
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Affiliation(s)
- Shimeng Wang
- Department of Oral Medicine, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Frontier Innovation Center for Dental Medicine Plus, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jun Sun
- Department of Oral Medicine, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Frontier Innovation Center for Dental Medicine Plus, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Oral Medicine, Stomatological Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Shuzhi Deng
- Department of Oral Medicine, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Frontier Innovation Center for Dental Medicine Plus, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Lanyan Wu
- Department of Oral Pathology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Wei Li
- Department of Dermatology & Rare Disease Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tingpei Ye
- Department of Oral Medicine, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Frontier Innovation Center for Dental Medicine Plus, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Fanglong Wu
- Department of Oral Medicine, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Frontier Innovation Center for Dental Medicine Plus, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yang Wu
- Department of Oral Medicine, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Frontier Innovation Center for Dental Medicine Plus, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of General Dentistry, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hongmei Zhou
- Department of Oral Medicine, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Frontier Innovation Center for Dental Medicine Plus, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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3
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Zhou S, Zhang Z, Feng X, Zhao C, Jiang L. Lichenoid mucocutaneous reactions associated with sintilimab therapy in a non-small cell lung adenocarcinoma patient: case report and review. Front Pharmacol 2023; 14:1276788. [PMID: 38161699 PMCID: PMC10756897 DOI: 10.3389/fphar.2023.1276788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
The immune checkpoint inhibitor (ICI), anti-programmed cell death receptor-1 (PD-1) antibody, has gained widespread approval for treating various malignancies. Among the immune-related adverse reactions (irAEs) during ICI treatment, the lichenoid reaction is noteworthy. Sintilimab, a new PD-1 inhibitor, has secured approval in China for treating refractory non-Hodgkin's lymphoma, and phase I/II clinical trials for other solid tumors are ongoing both domestically and abroad. This paper presents a case of a mucocutaneous lichenoid reaction associated with sintilimab therapy, its diagnosis, and management. Our study, using multiplex immunofluorescence staining, reveals localized infiltration of CD4+ and CD8+ T lymphocytes in the subepithelial lamina propria region with upregulated PD-1 expression, implying an association between PD-1 expression upregulation and lichenoid reactions provoked by PD-1 monoclonal antibody. We provide a summary of clinical characteristics and treatment guidelines for lichenoid reactions induced by ICIs from previous reports, highlighting the success of a combined therapeutic regimen of oral antihistamines and topical corticosteroids in controlling symptoms without interrupting ICI treatment.
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Affiliation(s)
- Shuting Zhou
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Zhenyu Zhang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xiaodong Feng
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Chengjian Zhao
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, Sichuan, China
| | - Lu Jiang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Carmona-Rocha E, Aguado M, Tubau C, Sánchez S, Mozos A, Sullivan I, Spertino J. Epidermolysis bullosa acquisita ausgelöst durch Atezolizumab. J Dtsch Dermatol Ges 2023; 21:1407-1409. [PMID: 37946658 DOI: 10.1111/ddg.15203_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/09/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Elena Carmona-Rocha
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María Aguado
- Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carla Tubau
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sofía Sánchez
- Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Anna Mozos
- Anatomical Pathology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ivana Sullivan
- Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jorge Spertino
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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5
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Carmona-Rocha E, Aguado M, Tubau C, Sánchez S, Mozos A, Sullivan I, Spertino J. Epidermolysis bullosa acquisita induced by atezolizumab. J Dtsch Dermatol Ges 2023; 21:1407-1409. [PMID: 37658659 DOI: 10.1111/ddg.15203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/09/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Elena Carmona-Rocha
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María Aguado
- Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carla Tubau
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sofía Sánchez
- Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Anna Mozos
- Anatomical Pathology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ivana Sullivan
- Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jorge Spertino
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Madan V, Marchitto MC, Sunshine JC. Pembrolizumab-Induced Lichen Planus Pemphigoides in a Patient with Metastatic Adrenocortical Cancer: A Case Report and Literature Review. Dermatopathology (Basel) 2023; 10:244-258. [PMID: 37606485 PMCID: PMC10443361 DOI: 10.3390/dermatopathology10030033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023] Open
Abstract
While the advent of immune-checkpoint inhibitors has revolutionized cancer therapy, immune-related adverse effects (irAEs) have also been on the rise. Cutaneous toxicities are among the most common irAEs, especially in the context of programmed cell death protein-1 (PD-1) inhibitors like pembrolizumab. Herein, we report a case of anti-PD-1-induced lichen planus pemphigoides (LPP)-a rare autoimmune blistering disorder with characteristics of both lichen planus and bullous pemphigoid. To our knowledge, this is the first reported case of LPP following anti-PD-1 therapy for metastatic adrenocortical cancer. Recognizing that LPP is within the spectrum of irAEs is important, especially as the indications for immunotherapy grow to include rarer malignancies like adrenocortical cancer. In addition to our case presentation, we also provide a comprehensive review of the literature surrounding immunotherapy-induced LPP-highlighting key characteristics towards the early recognition and clinical management of this cutaneous irAE.
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Affiliation(s)
| | | | - Joel C. Sunshine
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (V.M.)
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Merli M, Accorinti M, Romagnuolo M, Marzano A, Di Zenzo G, Moro F, Antiga E, Maglie R, Cozzani E, Parodi A, Gasparini G, Sollena P, De Simone C, Caproni M, Pisano L, Fattore D, Balestri R, Sena P, Vezzoli P, Teoli M, Ardigò M, Vassallo C, Michelerio A, Satta RR, Dika E, Melotti B, Ribero S, Quaglino P. Autoimmune bullous dermatoses in cancer patients treated by immunotherapy: a literature review and Italian multicentric experience. Front Med (Lausanne) 2023; 10:1208418. [PMID: 37547602 PMCID: PMC10400335 DOI: 10.3389/fmed.2023.1208418] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Cutaneous immune-related adverse events are frequently associated with immune checkpoint inhibitors (ICIs) administration in cancer patients. In fact, these monoclonal antibodies bind the cytotoxic T-lymphocyte antigen-4 and programmed cell death-1/ligand 1 leading to a non-specific activation of the immune system against both tumoral cells and self-antigens. The skin is the most frequently affected organ system appearing involved especially by inflammatory manifestations such as maculopapular, lichenoid, psoriatic, and eczematous eruptions. Although less common, ICI-induced autoimmune blistering diseases have also been reported, with an estimated overall incidence of less than 5%. Bullous pemphigoid-like eruption is the predominant phenotype, while lichen planus pemphigoides, pemphigus vulgaris, and mucous membrane pemphigoid have been described anecdotally. Overall, they have a wide range of clinical presentations and often overlap with each other leading to a delayed diagnosis. Achieving adequate control of skin toxicity in these cases often requires immunosuppressive systemic therapies and/or interruption of ICI treatment, presenting a therapeutic challenge in the context of cancer management. In this study, we present a case series from Italy based on a multicenter, retrospective, observational study, which included 45 patients treated with ICIs who developed ICI-induced bullous pemphigoid. In addition, we performed a comprehensive review to identify the cases reported in the literature on ICI-induced autoimmune bullous diseases. Several theories seeking their underlying pathogenesis have been reported and this work aims to better understand what is known so far on this issue.
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Affiliation(s)
- Martina Merli
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Martina Accorinti
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maurizio Romagnuolo
- Dermatology Unit, Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Angelo Marzano
- Dermatology Unit, Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Giovanni Di Zenzo
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Francesco Moro
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Emiliano Antiga
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Roberto Maglie
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Emanuele Cozzani
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Dermatology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Dermatology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giulia Gasparini
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Dermatology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pietro Sollena
- Dermatology Unit, Department of Surgical and Medical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Clara De Simone
- Dermatology Unit, Department of Surgical and Medical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dermatology Unit, University Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Marzia Caproni
- Immunopathology and Rare Skin Diseases Unit, Section of Dermatology, Department of Health Sciences, Azienda Unità Sanitaria Locale Toscana Centro, University of Florence, Florence, Italy
| | - Luigi Pisano
- Section of Dermatology, Department of Health Sciences, Azienda Unità Sanitaria Locale Toscana Centro, University of Florence, Florence, Italy
| | - Davide Fattore
- Section of Dermatology, Department of Clinical Medicine and Surgery, Università Degli Studi di Napoli Federico II, Naples, Italy
| | - Riccardo Balestri
- Division of Dermatology, Outpatient Consultation for Rare Diseases, APSS, Trento, Italy
| | - Paolo Sena
- Dermatology Unit ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Pamela Vezzoli
- Dermatology Unit ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Miriam Teoli
- Porphyria and Rare Diseases, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Marco Ardigò
- Porphyria and Rare Diseases, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Camilla Vassallo
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Michelerio
- Dermatology Unit, Ospedale Cardinal Massaia, Asti, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Rosanna Rita Satta
- Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Emi Dika
- Melanoma Center, Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Unit of Dermatology, Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Barbara Melotti
- Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Simone Ribero
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
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Liu SS, Howard T, Fattah YH, Adams A, Hanly AJ, Karai LJ. Lichen Planopilaris Pemphigoides: A Novel Bullous Dermatosis Due to Programmed Cell Death Protein-1 Inhibitor Therapy. Am J Dermatopathol 2023; 45:246-249. [PMID: 36825932 PMCID: PMC10018802 DOI: 10.1097/dad.0000000000002392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
ABSTRACT Lichen planus pemphigoides (LPPemph), apart from bullous pemphigoid, is a rare bullous dermatosis that can be induced by programmed cell death protein-1 (PD-1)/PD ligand 1 (PD-L1) inhibitors. The primary location of PD-1/PD-L1 inhibitor-induced LPPemph has previously only been reported at the nonfollicular dermal-epidermal junction. We present a case of nivolumab-induced LPPemph with an intense perifollicular lichenoid reaction, prominent multifocal perifollicular clefting, which in addition, was also accompanied by linear IgG and C3 immunofluorescence deposits along the dermal-epidermal junction as well as demonstrating a perifollicular pattern. Intriguingly, the serological study of BP180 and BP230 antibodies was negative, suggesting the presence of additional novel antibodies, which primarily favor hair follicles and may contribute to the pathogenesis. Therefore, we consider this entity a novel variant of PD-1/PD-L1 inhibitor-induced bullous dermatosis. To the best of our knowledge, this is the first report that highlights perifollicular bullae accompanied by immunofluorescence findings in a PD-1/PD-L1 inhibitor-induced lesion. We propose a new immunotherapy associated entity, lichen planopilaris pemphigoides, and emphasize the significance of perifollicular changes in the pathogenesis.
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Affiliation(s)
- Shuo S. Liu
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
| | - Tara Howard
- University of Miami, Holy Cross Hospital, Ft. Lauderdale, FL
| | - Yasmin H. Fattah
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
| | - Amy Adams
- South Central Dermatology Clinic, Laurel, MS; and
| | | | - Laszlo J. Karai
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
- Global Pathology, Sonic Healthcare USA, Miami Lakes, FL
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Buján Bonino C, López-Pardo Rico M, Moreiras Arias N, Suárez Peñaranda JM, Casas Fernández L. Checkpoint inhibitor-induced lichen planus pemphigoides: a case report and literature review of an unusually reported entity. Int J Dermatol 2023; 62:e200-e204. [PMID: 36371713 DOI: 10.1111/ijd.16502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/24/2022] [Accepted: 10/27/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Cecilia Buján Bonino
- Department of Dermatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - María López-Pardo Rico
- Department of Dermatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Noelia Moreiras Arias
- Department of Dermatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - José M Suárez Peñaranda
- Department of Pathology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
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Alharbi A, Khobrani A, Noor A, Alghamdi W, Alotaibi A, Alnuhait M, Haseeb A. Risk of Lichen Sclerosus and Lichen Planus in Patients Receiving Immune Checkpoint Inhibitors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:580. [PMID: 36612904 PMCID: PMC9819784 DOI: 10.3390/ijerph20010580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) are recommended for various types of cancer. On the other hand, these ICIs may cause immune-related adverse events (irAEs). Lichen sclerosus (LS) and lichen planus (LP) are two distinct phenotypes of irAEs that occur in a subset of patients treated with ICIs. These adverse effects have a detrimental effect on the patient's quality of life and treatment phases; however, the clinical evaluation and assessment of LS and LP remain uncertain. This study aims to assess and evaluate the risk of LS and LP associated with the use of ICIs via a systematic review of the literature and the USA FDA Adverse Events FAERS database. METHOD The study searched electronic databases such as PubMed, Medline, Cochrane, and Google Scholar for case reports on immune-checkpoint-inhibitor-associated lichen sclerosus and lichen planus published in English between inception and 31 December 2021. The FDA's adverse event reporting system (FAERS) database was also analyzed. RESULTS Thirty-eight case reports and two retrospective studies with a total of 101 patients, in addition to the FAERS data, were evaluated. More cases involved lichen planus (78.9%) than lichen sclerosis (21%). Nivolumab and pembrolizumab were most frequently reported with LS and LP, among other ICIs. Thirty-six out of thirty-eight patients with LS or LP experienced complete remission, while two patients experienced partial remission. Most of the cases had an excellent response to corticosteroids (92.1%), while the remainder had moderate (5.2%) and poor (2.6%) responses. Additionally, the reporting odds ratio (ROR) of the FAERS database indicated a favorable association for ICIs, the risk of LP, and LS. A stronger association was uniquely found between nivolumab and pembrolizumab. CONCLUSION There have been published case reports for these adverse events. Healthcare providers should be aware of the possibility of lichen sclerosis and lichen planus developing in patients receiving ICIs which could necessitate hospitalization or discontinuation. Regulatory agencies are advised to monitor the risks as a potential safety signal.
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Affiliation(s)
- Ahmad Alharbi
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
- Qassim Health Cluster, Ministry of Health, Buraidah 52385, Saudi Arabia
| | - Attiah Khobrani
- Pharmaceutical Care Services, King Abdullah Medical City, Ministry of Health, Makkah 21955, Saudi Arabia
| | - Afnan Noor
- Pharmaceutical Care Department, King Faisal Specialist Hospital & Research Center, Jeddah 22234, Saudi Arabia
| | - Waad Alghamdi
- Pharmacovigilance Directorate, Saudi Food and Drug Authority, Riyadh 13513, Saudi Arabia
| | - Abdulmalik Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Mohammed Alnuhait
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
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11
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Immunotherapy for Melanoma: The Significance of Immune Checkpoint Inhibitors for the Treatment of Advanced Melanoma. Int J Mol Sci 2022; 23:ijms232415720. [PMID: 36555362 PMCID: PMC9779655 DOI: 10.3390/ijms232415720] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Therapeutic options for treating advanced melanoma have progressed rapidly in recent decades. Until 6 years ago, the regimen for treating advanced melanoma consisted mainly of cytotoxic agents such as dacarbazine and type I interferons. Since 2014, anti-programmed cell death 1 (PD1) antibodies have been recognized as anchor drugs for treating advanced melanoma, with or without additional combination drugs such as ipilimumab, but the efficacies of these immunotherapies are not fully satisfactory. In this review, we describe the development of the currently available anti-PD1 Abs-based immunotherapies for advanced melanoma, focusing on their efficacy and immune-related adverse events (AEs), as well as clinical trials still ongoing for the future treatment of advanced melanoma.
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12
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Boyle MM, Ashi S, Puiu T, Reimer D, Sokumbi O, Soltani K, Onajin O. Lichen Planus Pemphigoides Associated With PD-1 and PD-L1 Inhibitors: A Case Series and Review of the Literature. Am J Dermatopathol 2022; 44:360-367. [PMID: 35120032 DOI: 10.1097/dad.0000000000002139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Immune checkpoint inhibitors are increasingly being used in the treatment of various solid organ and hematologic malignancies. Dermatologic toxicities associated with programmed cell death protein-1 (PD-1) and programmed death ligand-1 (PD-L1) therapy have been widely reported in the literature. It is important for clinicians to be aware of these toxicities to ensure prompt recognition and treatment. Herein, we present the clinical, histopathologic, and immunofluorescence findings of 3 patients diagnosed with lichen planus pemphigoides (LPP) after treatment with anti-PD-1 inhibitors. We also reviewed the literature and summarize 7 previously reported cases of LPP associated with anti-PD-1 and anti-PD-L1 inhibitors. LPP was diagnosed at a median time of 24.4 weeks (range: 4-78 weeks) after initiation of immunotherapy. Clinical findings included papules, plaques, erosions, vesicles, and bullae on the trunk and extremities. Oral involvement was present in half the cases. Histopathologic features of immunotherapy-induced LPP included lichenoid or vacuolar interface dermatitis, the presence of eosinophils, and subepidermal bullae. Direct immunofluorescence demonstrated linear deposition of immunoglobulin G (IgG) or C3. Indirect immunofluorescence demonstrated linear IgG along basement membrane zone on monkey esophagus in 2 cases and linear IgG on the epidermal side of salt split skin in 3 cases. Serum anti-BP180 was elevated in all cases in which enzyme-linked immunosorbent assay was performed.
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Affiliation(s)
- Margaret M Boyle
- Section of Dermatology, Department of Medicine, University of Chicago, Chicago IL; and
| | - Shaymaa Ashi
- Section of Dermatology, Department of Medicine, University of Chicago, Chicago IL; and
| | - Tudor Puiu
- Department of Dermatology, Mayo Clinic, Jacksonville, FL
| | | | | | - Keyoumars Soltani
- Section of Dermatology, Department of Medicine, University of Chicago, Chicago IL; and
| | - Oluwakemi Onajin
- Section of Dermatology, Department of Medicine, University of Chicago, Chicago IL; and
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13
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Niebel D, Wilsmann-Theis D, Bieber T, Berneburg M, Wenzel J, Braegelmann C. Bullous Pemphigoid in Patients Receiving Immune-Checkpoint Inhibitors and Psoriatic Patients—Focus on Clinical and Histopathological Variation. Dermatopathology (Basel) 2022; 9:60-81. [PMID: 35323203 PMCID: PMC8947168 DOI: 10.3390/dermatopathology9010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 12/07/2022] Open
Abstract
Background: The most common autoimmune blistering disease, bullous pemphigoid (BP), shows an increased prevalence in psoriatic patients and oncologic patients undergoing immune-checkpoint blockade (ICB). Even though the same autoantigens (BP180/BP230) are detectable, it remains obscure whether clinical or histopathological differences exist between these different groups of BP patients. In this study, we strived to analyze this matter based on own data and previously published reports. Methods: We performed an institutional chart review from 2010–2020 to identify BP patients with psoriasis (n = 6) or underlying ICB (n = 4) and matched them with idiopathic cases of BP (n = 33). We compared clinical characteristics, subtypes, and dermatopathological determinants (e.g., tissue eosinophilia/neutrophilia, papillary edema, lymphocytic infiltration) among the groups. Results: ICB-associated BP affects men more often and might show mucosal involvement more frequently. We found no statistically significant dermatopathological differences among the groups. Conclusions: Clinicians should be aware of an increased risk of BP in patients with psoriasis and oncologic patients receiving ICB; atypical pruritic skin lesions should prompt a workup including a skin biopsy for histopathology and direct immunofluorescence in these patients. Larger studies might be necessary to detect slight dermatopathological variation.
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Affiliation(s)
- Dennis Niebel
- Department of Dermatology, University Hospital Regensburg, 93053 Regensburg, Germany;
- Correspondence: ; Tel.: +49-941-944-9620
| | - Dagmar Wilsmann-Theis
- Department of Dermatology and Allergy, University Hospital Bonn, 53105 Bonn, Germany; (D.W.-T.); (T.B.); (J.W.); (C.B.)
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital Bonn, 53105 Bonn, Germany; (D.W.-T.); (T.B.); (J.W.); (C.B.)
| | - Mark Berneburg
- Department of Dermatology, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Joerg Wenzel
- Department of Dermatology and Allergy, University Hospital Bonn, 53105 Bonn, Germany; (D.W.-T.); (T.B.); (J.W.); (C.B.)
| | - Christine Braegelmann
- Department of Dermatology and Allergy, University Hospital Bonn, 53105 Bonn, Germany; (D.W.-T.); (T.B.); (J.W.); (C.B.)
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14
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Pospischil I, Hoetzenecker W. Arzneimittelexantheme unter modernen zielgerichteten Therapien - Immuncheckpoint- und EGFR-Inhibitoren. J Dtsch Dermatol Ges 2021; 19:1621-1645. [PMID: 34811897 DOI: 10.1111/ddg.14641_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/19/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Isabella Pospischil
- Universitätsklinik für Dermatologie und Venerologie, Kepler Universitätsklinikum, Johannes Kepler Universität, Linz, Österreich
| | - Wolfram Hoetzenecker
- Universitätsklinik für Dermatologie und Venerologie, Kepler Universitätsklinikum, Johannes Kepler Universität, Linz, Österreich
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15
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Pospischil I, Hoetzenecker W. Drug eruptions with novel targeted therapies - immune checkpoint and EGFR inhibitors. J Dtsch Dermatol Ges 2021; 19:1621-1643. [PMID: 34811916 PMCID: PMC9299005 DOI: 10.1111/ddg.14641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/19/2021] [Indexed: 12/25/2022]
Abstract
Given the increasing use of novel targeted therapies, dermatologists are constantly confronted with novel cutaneous side effects of these agents. A rapid diagnosis and appropriate management of these side effects are crucial to prevent impairment of the patients' quality of life and interruptions of essential cancer treatments. Immune checkpoint and EGFR inhibitors are frequently used targeted therapies for various malignancies and are associated with a distinct spectrum of cutaneous adverse events. Exanthematous drug eruptions represent a particular diagnostic challenge in these patients. Immune checkpoint inhibitors can elicit a plethora of immune-related exanthemas, most commonly maculopapular, lichenoid, and psoriasiform eruptions. Additionally, autoimmune bullous dermatoses and exanthemas associated with connective tissue diseases may arise. In cases of severe, atypical or therapy-resistant presentations an extensive dermatological investigation including a skin biopsy is recommended. Topical and systemic steroids are the mainstay of treatment. Papulopustular eruptions represent the major cutaneous adverse effect of EGFR inhibitor therapy, occurring in up to 90 % of patients within the first two weeks of therapy, depending on the agent. Besides topical antibiotics and steroids, oral tetracyclines are the first choice in systemic treatment and can also be used as prophylaxis.
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Affiliation(s)
- Isabella Pospischil
- Department of Dermatology, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Wolfram Hoetzenecker
- Department of Dermatology, Kepler University Hospital, Johannes Kepler University, Linz, Austria
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16
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Manko S, Côté B, Provost N. A case of durvalumab-induced lichenoid eruption evolving to bullous eruption after phototherapy: A case report. SAGE Open Med Case Rep 2021; 9:2050313X21993279. [PMID: 33747513 PMCID: PMC7940716 DOI: 10.1177/2050313x21993279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/09/2020] [Indexed: 11/29/2022] Open
Abstract
Immune checkpoint inhibitor therapy nowadays became a treatment for a wide range of cancers, and may be responsible for various dermatologic adverse effects, including bullous eruptions. In our report, we present a case of late-onset immunotherapy-induced eruption in a 62-year-old woman treated with anti-programmed cell death-L1 agent durvalumab for metastatic squamous cell carcinoma. Diagnosed as lichenoid dermatitis upon initial presentation, this eruption evolved into necrotic bullous dermatitis after several weeks of phototherapy, with histology and direct immunofluorescence study favoring lichen planus pemphigoides. Thus, this case may be regarded as durvalumab-induced lichenoid dermatitis with phototherapy-triggered progression to necrotic lichen planus pemphigoides-like eruption. The patient's eruption responded to oral prednisone and immunotherapy interruption. Interestingly, durvalumab reintroduction in this patient led to recurrent lichenoid dermatitis without bullous component. This case of immunotherapy skin toxicity is rather distinctive by its clinical and histopathologic features, with phototherapy as an additional triggering factor.
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Affiliation(s)
- Svitlana Manko
- Department of Dermatology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Benoît Côté
- Department of Dermatology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Nathalie Provost
- Department of Dermatology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
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