We report phenotypic switching from atopic dermatitis to psoriasis in a 44‐year‐old man during treatment with upadacitinib. The patient also had experienced a similar course with dupilumab. This case exemplifies mutual antagonism between atopic dermatitis and psoriasis in predisposed individuals.
Immune checkpoint inhibitors (ICIs) are a relatively novel class of drugs whose administration has been approved for several malignancies. Adverse events are quite common, and the skin is the most frequently involved organ. In fact, regardless of the neoplasm being treated, more than 50% of patients receiving ICIs develop cutaneous immune-related adverse events (irAEs), with variable time to onset and severity. Potential pathogenetic mechanisms include drug-induced formation of neoantigens, unmasking of hidden selfantigens, and diffuse keratinocyte apoptosis induced by CD4+ and CD8+ T cell activation. Risk of cutaneous irAEs seems to be higher after anti-CTLA-4 rather than anti-PD-1/PD-L1 agent administration and rises in case of combination therapy. Furthermore, incidence of skin toxicity increases in the presence of specific malignancies (i.e., advanced melanoma) and pre-existing dermatoses or autoimmune diseases, while the possible role of ethnicity is still unclear. Aim of this review is to summarise the current knowledge of cutaneous irAEs and provide the clinician with a detailed clinical and histopathological description of the following types of skin toxicity: inflammatory dermatoses, immunobullous diseases, alterations of melanocytes, alterations of keratinocytes, hair abnormalities, oral and nail involvement. Particular attention is given to practical management of the different cutaneous irAEs, including detailed information about treatment regimens and necessity for ICI discontinuation. Patients should always receive multidisciplinary care, especially in severe or recalcitrant cases. The role of the dermatologists remains pivotal, particularly with regard to differential diagnosis and management of complex skin toxicity, as well as regular longterm follow-up of the patient's conditions.
(1) Background: Kaposi’s sarcoma (KS) is an angioproliferative neoplasm typically appearing as angiomatous patches, plaques, and/or nodules on the skin. Dermoscopy and ultrasonography have been suggested as an aid in the diagnosis of KS, but there is little evidence in the literature, especially regarding its possible differential diagnoses. Our aim is to describe and compare the clinical, dermoscopic, and ultrasonographic features of KS and KS-like lesions. (2) Methods: we conducted a prospective study on 25 consecutive patients who were first referred to our tertiary care center from January to May 2021 for a possible KS. (3) Results: 41 cutaneous lesions were examined by means of dermoscopy, Doppler ultrasonography, and pathology, 32 of which were KS-related, while the remaining 9 were lesions with clinical resemblance to KS. On dermoscopy, a purplish-red pigmentation, scaly surface, and the collarette sign were the most common features among KS lesions (81.3%, 46.9%, and 28.1%, respectively). On US, all 9 KS plaques and 21 KS nodules presented a hypoechoic image. Dermoscopic and Doppler ultrasonographic findings of KS-like lesions, such as cherry angioma, venous lake, glomus tumor, pyogenic granuloma, and angiosarcoma were also analyzed. (4) Conclusions: dermoscopy and Doppler ultrasonography can be useful to better assess the features of KS lesions and in diagnosing equivocal KS-like lesions.
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