Dermal elastolysis in the setting of combination immunotherapy

Abstract

Multiple cutaneous side effects have been reported with the use of immunotherapies including programmed cell death protein 1 inhibitors. We report 2 patients who presented with papillary dermal elastolysis presenting as multiple, skin‐colored, wrinkled papules and atrophic macules following an inflammatory eruption in the setting of combination chemotherapy with nivolumab and cabiralizumab. These two cases highlight a novel finding, elastolysis in the setting of chemotherapy with nivolumab and cabiralizumab.

Papillary Dermal Elastolysis Secondary to Combination Nivolumab and Cabiralizumab Therapy: Histiocytes and Dermal Mucin as Clues to the Diagnosis

“…Interestingly, Dickinson et al 2 recently reported 2 patients with strikingly similar clinical and histopathologic findings to our patient. They describe papillary dermal elastolysis with generalized, punched-out, atrophic macules and papules after an inflammatory eruption also in the setting of combination nivolumab and cabiralizumab immunotherapy.…”

“…1 Recently, papillary dermal elastolysis was linked to emerging immunotherapies used in cancer treatment. 2 Herein, we present an additional case, with an emphasis on the histopathological findings of dermal histiocytes and markedly increased dermal mucin as clues to the diagnosis and possible pathogenesis.…”

Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update

“…7,[18][19][20] Although they may occur in the context of anti-PD-1 [21][22][23] and anti-PD-L1 therapy, 24 cutaneous irAEs are more frequently observed with CTLA-4 inhibitors alone or in combination with anti-PD-1 agents. 8,25,26 Although cutaneous irAEs may occur in individuals with diverse tumor types, 27 they are most often reported in individuals with melanoma 7,[28][29][30][31][32] and non-small-cell lung cancer (NSCLC). [33][34][35][36] Cutaneous toxicities are often the earliest observed irAEs, 26 typically noted within 3 weeks after the initiation of ipilimumab and within 6 weeks following the start of anti-PD-1 therapy; however, their onset can be delayed, even after completion of therapy.…”

Punctate Anetoderma After Colony-Stimulating Factor 1 Receptor and Programmed Cell Death 1 Blockade With Irradiation

“…Limitations of this study include its observational nature and small sample size. A previous report describes 2 patients receiving treatment with nivolumab and cabiralizumab who developed atrophic lesions characterized histologically by dermal elastolysis, which likely represents the same phenomenon seen in the present cohort. We suspect that additional cases of punctate anetoderma will emerge with increasing use of these combination therapies.…”