An Atypical Presentation of Lichen Planus-Like Reaction from Pembrolizumab

Abstract

Introduction. With the advent of immunotherapy, a new subtype of side effects called IRAEs or immune related adverse effects have become more common. They may present in various organ systems as colitis, pneumonitis, hypophysitis, and thyroiditis and commonly as dermatological reactions. Case. This is a case report of a lung cancer patient that was started on Pembrolizumab and developed shortly after what appeared to be clinically at first pustular psoriasis but on biopsy was confirmed to be lichen planus. She was discontinued on the Pembrolizumab and treated with both systemic and topical steroids and improved. Conclusion. This case highlights a cutaneous reaction from Pembrolizumab and the subsequent management that helped resolve her condition but also weighing the benefits against the risk of treatments and potential prognostic implications of having cutaneous side effects.

Pustular Lichenoid Eruptions Induced by Immune Checkpoint Inhibitors: Two Case Reports and a Review of the Literature

“…7 Topical corticosteroids provided complete healing of cutaneous lesions in the case of the French Pharmacovigilance Database within 4 months. The evolution of the skin rash was described in only 2 cases of the literature 8,9 and lichenoid dermatitis slowly improved within several months, as we also observed in our 2 patients.…”

“…We also reviewed the French Pharmacovigilance Database. We identified 5 cases in the published literature4,7–9 and 1 case in the French Pharmacovigilance Database with a pustular presentation of lichenoid lesions. Their characteristics are summarized in Table 1.…”

“…Anti-PD-1 therapy was discontinued in 3 published cases 8,9 and in the case of the French Pharmacovigilance Database because of severe lesions at onset or worsening during follow-up. Treatment was continued in 1 case, 7 however, rash evolution was not reported.…”

Cutaneous adverse reactions in a lung cancer patient treated with pembrolizumab: A case report

“…Immunotherapy was continued but some eczematous, psoriasiform and lichenoid secondary cutaneous side effects developed, which were localized on the left mandible and left superior limb and had a partial response to corticoid treatment with full resolution following pembrolizumab treatment termination (Figs. 2 and 3) (9)(10)(11)(12).…”

Expert guidance on prophylaxis and treatment of dermatologic adverse events with Tumor Treating Fields (TTFields) therapy in the thoracic region

“…For example, radiation therapy induces dermatitis, which can be erosive or ulcerative, and chemotherapies can damage hair, skin, and nails, due to their cytotoxic nature ( 19 , 20 ). Furthermore, immunotherapies can instigate immune-related AEs, including psoriasiform, lichenoid, and blistering dermatitis ( 20 , 21 ), or other skin AEs, including rash, skin thickening, and itching ( 22 – 24 ).…”