Immune checkpoint inhibitor–related dermatologic adverse events
| Autor: | Gregory S. Phillips, Jeffrey A. Kern, Amaris Geisler, Donald Y.M. Leung, Mario E. Lacouture, Jennifer W. Wu, Andrea P Moy, Dulce M. Barrios |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
integumentary system business.industry Dermatology Vitiligo medicine.disease Rash Toxic epidermal necrolysis 030207 dermatology & venereal diseases 03 medical and health sciences 0302 clinical medicine Depigmentation Neoplasms 030220 oncology & carcinogenesis Lichenoid eruption medicine Maculopapular rash Humans Drug Eruptions Bullous pemphigoid medicine.symptom PD-L1 inhibitor business Immune Checkpoint Inhibitors |
| Zdroj: | Journal of the American Academy of Dermatology. 83:1255-1268 |
| ISSN: | 0190-9622 |
| Popis: | Immune checkpoint inhibitors have emerged as a pillar in the management of advanced malignancies. However, nonspecific immune activation may lead to immune-related adverse events, wherein the skin and its appendages are the most frequent targets. Cutaneous immune-related adverse events include a diverse group of inflammatory reactions, with maculopapular rash, pruritus, psoriasiform and lichenoid eruptions being the most prevalent subtypes. Cutaneous immune-related adverse events occur early, with maculopapular rash presenting within the first 6 weeks after the initial immune checkpoint inhibitor dose. Management involves the use of topical corticosteroids for mild to moderate (grades 1-2) rash, addition of systemic corticosteroids for severe (grade 3) rash, and discontinuation of immunotherapy with grade 4 rash. Bullous pemphigoid eruptions, vitiligo-like skin hypopigmentation/depigmentation, and psoriasiform rash are more often attributed to programmed cell death-1/programmed cell death ligand-1 inhibitors. The treatment of bullous pemphigoid eruptions is similar to the treatment of maculopapular rash and lichenoid eruptions, with the addition of rituximab in grade 3-4 rash. Skin hypopigmentation/depigmentation does not require specific dermatologic treatment aside from photoprotective measures. In addition to topical corticosteroids, psoriasiform rash may be managed with vitamin D3 analogues, narrowband ultraviolet B light phototherapy, retinoids, or immunomodulatory biologic agents. Stevens–Johnson syndrome and other severe cutaneous immune-related adverse events, although rare, have also been associated with checkpoint blockade and require inpatient care as well as urgent dermatology consultation. |
| Databáze: | OpenAIRE |
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