Hypersensibilité retardée aux tatouages induite par un traitement combiné anti-BRAF–anti-MEK

Rohmer, E.; Scrivener, J.-N.; Schissler, C.; Cribier, B.; Lenormand, C.

doi:10.1016/j.annder.2017.09.540

Cited by 3 publications

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“…What we observed, as described in other cases, suggests that treatment with dabrafenib and trametinib breaks the immune tolerance to, for example, tattoo ink, unmasking a hypersensitivity reaction (4).…”

Section: Discussionsupporting

confidence: 82%

“…Although cases of BRAF inhibitor-related sarcoidosis-like syndromes (especially cutaneous) have already been reported ( 4 ), to our knowledge, this is the first report of a case of BRAF plus MEK inhibitor adjuvant treatment-related systemic sarcoidosis-like syndrome. Sarcoidosis is a multisystemic disorder that can potentially affect any organ.…”

Section: Discussionmentioning

confidence: 80%

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Case Report: Immune-Related Toxicity During Adjuvant Treatment With BRAF Plus MEK Inhibitors in a Melanoma Patient

et al. 2020

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Adjuvant treatment of operated melanoma has deeply changed in the last few years with the introduction of immune-checkpoint inhibitors and BRAF/MEK inhibitors. Sarcoidosis is a systemic inflammatory disease causing non-caseous granulomatous reactions. Sarcoid-like granulomatous reactions have been reported in patients with advanced melanoma, mostly related to immunotherapy with immune-checkpoint inhibitors. We report a case of a 38-year-old woman with stage III operated melanoma treated with adjuvant BRAF plus MEK inhibitors, who developed sarcoidosis-like syndrome with systemic involvement, resolved after discontinuation of treatment. The occurrence of immune-related toxicity with the use of MAPK inhibitors supports the hypothesis that this class of drugs may also have an immunological effect, and that the long-term efficacy of adjuvant MAPK inhibitors may be due to their immunological function.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 80%

Case Report: Immune-Related Toxicity During Adjuvant Treatment With BRAF Plus MEK Inhibitors in a Melanoma Patient

et al. 2020

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“…Additional immunologic cofactors may be involved such as interferon initiation or restoration immune syndrome under HAART or vaccination . Besides, several cases of granulomatous tattoo reactions under BRAF and MEK inhibitors have been reported . They illustrate that immunity modulation can lead to a localized reaction against tattoos: the tattoos are the target , but not the cause of the reaction.…”

Section: Discussionmentioning

confidence: 99%

Tattoo‐associated uveitis with or without systemic sarcoidosis: a comparative review of the literature

Kluger

2018

Acad Dermatol Venereol

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Sarcoidosis is a systemic disease of unknown aetiology characterized by the presence of non-caseating epithelioid cell granulomas in multiple organs, mainly the lungs and the lymphatic system. It is also one of the leading cause of inflammatory eye diseases. For the past 70 years, sarcoidal granulomas on tattoos and permanent make-up have been documented. They can be the first and sometimes unique cutaneous manifestation of systemic sarcoidosis. A few cases of sarcoidosis with uveitis and granulomatous reactions within tattoos have been described. However, since the end 60s, a singular entity has been reported associating isolated uveitis with granulomatous cutaneous reaction restricted to tattoos in the notable absence of systemic sarcoidosis. It remains unclear whether this entity must be distinguished from sarcoidosis. This review summarizes the currently available data on this topic and compares cases of sarcoidosis with granulomatous tattoo reaction and uveitis to the cases without notable sarcoidosis. We propose the acronym TAGU (TAttoo Granulomas with Uveitis) as an exclusion diagnosis that emcompasses the patients for whom we fail to find any sarcoidosis or other causes after extensive investigation.

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Tattoo Reactions Associated with Targeted Therapies and Immune Checkpoint Inhibitors for Advanced Cancers: A Brief Review

Kluger

2019

Dermatology

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To the best of our knowledge, 10 cases (6 men, 4 women; mean age 44.5 years, range 22-59) have been reported since 2012. The main characteristics are summarized in Table 1. Six patients received a combination of BRAF inhibitor (BRAFi) associated with a MEK inhibitor (MEKi), 2 patients a PD-1/PD-L1 inhibitor (PD-1i/ PD-L1i) and 2 patients a CTLA-4 inhibitor (CTLA-4i), including one in combination with a PD-1i. We found that the clinical presentation was different according to culprit drugs. Tattoo eruption associated with BRAFi + MEKi presented mostly as a complete infiltration/induration of dark-colored tattoos with striking inflammatory borders in 5 out of 6 cases [10-13, 16]. Tattoo reactions with CTLA-4i or PD-1i/PD-L1i were reminiscent of what is usually observed with sarcoidosis or granulomatous tattoo reactions in general, e.g. papules and nodules scattered within black tattoos [8, 9, 14, 15]. Tattoos were dark/black in 86% (6/7) of the cases. In case of multicolored tattoos, other colors were spared. Delays of onset after the first cycle were as follows from the earliest to the latest: CTLA-4i + PD-1i (2 months) > BRAFi + MEKi (2-6 months) > PD-1i/PD-L1i (9-15 months). Only 1 patient had additional cutaneous sarcoids on plain skin and erythema nodosum [9]. Biopsies showed noncaseating granulomas in 67% (6/9), including all the cases with CTLA-4i and/or PD-1i/PD-L1i. In the 3 remaining cases, there was only a lymphocytic infiltration without any granulomas [10, 12, 13]. Angiotensin-converting enzyme was elevated in 2 cases of granulomatous reactions [9, 15]. Lung involvement and lymph nodes were reported in 60% (6/10). Management was highly variable according to authors. It included local corticosteroids, combination of local and systemic corticosteroids, abstention with either maintenance or discontinuation of the treatment, and switch to PD-1i or surgery. One patient experienced relapses with BRAFi + MEKi cycles [10]. Overall, outcome was always favorable. Discussion Granulomatous eruptions under ICPIs are an uncommon immune-related adverse event that can become more and more frequently encountered with the increased use of this therapeutic class [7]. All the patients under PD-1i/PD-L1i/CTLA-4i developed sarcoid-like reactions on tattoos. Delays of onset and outcomes were here in line with what is known from the literature [7]. On the other hand, cutaneous granulomatous reactions and sarcoidosis are rather infrequent with BRAFi [17]. Out of the 5 patients under BRAFi + MEKi with available biopsies, 3 displayed a lymphocytic infiltration in the dermis without granulomas. Besides, the clinical presentation was rather different with a marked erythema around the tattoos which is totally unusual compared to the usual tattoo granulomatous reactions we often see in practice [4, 18, 19]. Only 1 patient did not present such an inflammatory reaction around the affected tattoos [16]. To date, there is no case report of tattoo reaction with BRAFi alone. In 1 patient [11], the reaction developed 3 months after MEKi in...

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Hypersensibilité retardée aux tatouages induite par un traitement combiné anti-BRAF–anti-MEK

Cited by 3 publications

References 0 publications

Case Report: Immune-Related Toxicity During Adjuvant Treatment With BRAF Plus MEK Inhibitors in a Melanoma Patient

Case Report: Immune-Related Toxicity During Adjuvant Treatment With BRAF Plus MEK Inhibitors in a Melanoma Patient

Tattoo‐associated uveitis with or without systemic sarcoidosis: a comparative review of the literature

Tattoo Reactions Associated with Targeted Therapies and Immune Checkpoint Inhibitors for Advanced Cancers: A Brief Review

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