Jfri Abdulhadi, Leung Bonnie, Said Jordan T, Semenov Yevgeniy, LeBoeuf Nicole R
Dermatology Department, Harvard Medical School, Boston, MA, USA.
Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.
Immunother Adv. 2022 Sep 23;2(1):ltac016. doi: 10.1093/immadv/ltac016. eCollection 2022.
Cutaneous immune-related adverse events (irAEs) are the most common irAEs caused by immune-checkpoint inhibitors (ICI). Psoriasiform eruptions, both and flares, may occur. Evidence is lacking on inverse psoriasis subtype.
A retrospective study was conducted at Dana-Farber Cancer Institute/Mass General Brigham through February 2020 using databases. Confirmed inverse psoriasis cases pre-/post-ICI initiation either independently or in conjunction with other psoriasis subtypes were included. Known psoriasis cases without flare post-ICI were excluded.
A total of 262 (3%) individuals with any ICI-mediated psoriasiform cutaneous irAE were identified out of the 8683 DFCI ICI-treated patients. Of these, 13 (5% of psoriasis patients) had inverse psoriasis (mean age 68.7 years; 7/13 male sex). Median (range) time from ICI initiation to inverse psoriasis development or flare was 7 (4-12) and 3.5 (2-6) weeks, respectively. Pruritus occurred in 12/13 (92.30%) cases. 11 (85%) had inguinal involvement; other sites included gluteal cleft (6; 46%), inframammary (3; 23%), perianal (2; 15%), axilla (2; 15%), umbilicus (2; 15%), and infra-abdominal folds (1; 8%). Most (9/13) individuals had more than one site involved. The Common Terminology Criteria for Adverse Events severity was 1 in 10 (76.92%) individuals and 2 in 3 (15.38%) individuals. Six (46.15%) patients were treated initially by oncology with topical (nystatin, econazole, or clotrimazole) or systemic antifungals (fluconazole) for median (range) of 3.5 (1-7) months without improvement, for presumed candida intertrigo.
Patients on ICI may develop inverse psoriasis, which may be initially confused for fungal intertrigo. Delayed diagnosis can prolong symptoms, while patients are treated ineffectively with topical/systemic antifungals for presumed candida infection. Oncologist and dermatologist awareness is important to improve diagnosis of ICI-mediated inverse psoriasis, its management and affected patients' quality of life.
皮肤免疫相关不良事件（irAEs）是免疫检查点抑制剂（ICI）引起的最常见irAEs。可能会出现点滴状银屑病样皮疹和皮疹加重。关于反向银屑病亚型的证据不足。
在达纳-法伯癌症研究所/麻省总医院布莱根分院进行了一项回顾性研究，截止至2020年2月，使用数据库。纳入确诊的ICI开始使用前/后出现的反向银屑病病例，这些病例可以是单独出现，也可以与其他银屑病亚型同时出现。排除已知有银屑病但在ICI治疗后未出现皮疹加重的病例。
在8683例接受DFCI的ICI治疗的患者中，共确定了262例（3%）出现任何ICI介导的银屑病样皮肤irAE的个体。其中，13例（占银屑病患者的5%）患有反向银屑病（平均年龄68.7岁；13例中有7例为男性）。从开始使用ICI到出现反向银屑病或皮疹加重的中位（范围）时间分别为7（4 - 12）周和3.5（2 - 6）周。13例中有12例（92.30%）出现瘙痒。11例（85%）有腹股沟受累；其他部位包括臀裂（6例；46%）、乳房下（3例；23%）、肛周（2例；15%）、腋窝（2例；15%）、脐部（2例；15%）和下腹部褶皱（1例；8%）。大多数（9/13）个体有多个部位受累。不良事件通用术语标准严重程度为1级的有10例（76.92%）个体，2级的有3例（15.38%）个体。6例（46.15%）患者最初由肿瘤科医生使用局部（制霉菌素、益康唑或克霉唑）或全身性抗真菌药（氟康唑）治疗，中位（范围）治疗3.5（1 - 7）个月，因疑似念珠菌间擦疹而无改善。
接受ICI治疗的患者可能会出现反向银屑病，最初可能被误诊为真菌性间擦疹。延迟诊断会延长症状持续时间，同时患者因疑似念珠菌感染而接受局部/全身性抗真菌药治疗无效。肿瘤学家和皮肤科医生提高对ICI介导的反向银屑病的诊断、管理以及对受影响患者生活质量的认识很重要。
