Hashimoto Hiroki, Ito Takamichi, Ichiki Toshio, Yamada Yuichi, Oda Yoshinao, Furue Masutaka
Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
J Clin Med. 2021 Feb 12;10(4):728. doi: 10.3390/jcm10040728.
Immune checkpoint inhibitors (ICIs) cause a variety of inflammatory eruptions. The understanding of ICI-induced inflammatory eruptions with detailed histopathological findings is not adequate, particularly in Asian populations. In this study, we retrospectively reviewed 51 patients who were histopathologically diagnosed with cutaneous immune-related adverse events (irAEs) following ICI therapy between 2014 and 2020 at the Department of Dermatology of Kyushu University Hospital. Of the 51 patients (30 men, 21 women), maculopapular rash (38/51, 74.5%), erythema multiforme (2/51, 3.9%), lichenoid reaction (3/51, 5.9%), psoriasiform reaction (3/51, 5.9%), bullous pemphigoid (3/51, 5.9%), scleroderma-like reaction (1/51, 2.0%), and Stevens-Johnson syndrome (1/51, 2.0%) were observed. The clinical and histopathological findings of these eruptions were equivalent to typical cases of common drug eruptions. The onset of maculopapular rash was relatively early (more than half of events occurred within 1 month), whereas lichenoid reactions and autoimmune diseases occurred relatively late (4-8 months). With appropriate treatment and/or interruption of ICIs, most rashes improved (50/51, 98.0%). The ICI-induced inflammatory eruptions shared similar clinical and histopathological features with classical inflammatory eruptions, but a variety of inflammatory eruptions may occur with different degrees of severity. Dermatologists play an important role in providing specialized care for cutaneous irAEs.
免疫检查点抑制剂（ICI）可引发多种炎症性皮疹。目前对ICI诱导的炎症性皮疹及其详细组织病理学表现的了解尚不充分，尤其是在亚洲人群中。在本研究中，我们回顾性分析了2014年至2020年间在九州大学医院皮肤科接受ICI治疗后经组织病理学诊断为皮肤免疫相关不良事件（irAE）的51例患者。在这51例患者中（30例男性，21例女性），观察到斑丘疹（38/51，74.5%）、多形红斑（2/51，3.9%）、苔藓样反应（3/51，5.9%）、银屑病样反应（3/51，5.9%）、大疱性类天疱疮（3/51，5.9%）、硬皮病样反应（1/51，2.0%）和史蒂文斯-约翰逊综合征（1/51，2.0%）。这些皮疹的临床和组织病理学表现与常见药物性皮疹的典型病例相当。斑丘疹的发病相对较早（超过半数的病例在1个月内发生），而苔藓样反应和自身免疫性疾病的发生相对较晚（4 - 8个月）。通过适当的治疗和/或中断ICI，大多数皮疹得到改善（50/51，98.0%）。ICI诱导的炎症性皮疹与经典炎症性皮疹具有相似的临床和组织病理学特征，但可能会出现各种不同严重程度的炎症性皮疹。皮肤科医生在为皮肤irAE提供专科护理方面发挥着重要作用。
