Rupioid psoriasis presents with extensive hyperkeratotic plaques

Cavazos, Annia; Benjanuwattra, Juthipong; Morataya, Cristina; Abdelnabi, Mahmoud

doi:10.1136/bcr-2022-252500

Cited by 1 publication

(3 citation statements)

References 7 publications

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Section: Discussionmentioning

confidence: 99%

“…The term 'rupioid' is used to describe a well-defined, grossly cone-shaped, circular, thick keratotic lesion resembling the limpet shell or oyster shell [3][4][5][6]. This rupioid clinical aspect of the lesions can be observed in psoriasis, secondary syphilis, Norwegian scabies, HIV, sarcoidosis, reactive arthritis, disseminated histoplasmosis, or acrokeratosis paraneoplastica [4][5][6]. It's important to exclude acrokeratosis paraneoplastic condition, also known as Bazex syndrome, especially when erythematous rashes and psoriasiform scales are localized mostly in acral sites because it can be associated with squamous cell carcinoma of the aerodigestive tracts.…”

Section: Discussionmentioning

confidence: 99%

“…Drug-provoked rupioid psoriasis (either drug-aggravated or drug-induced) is similarly infrequent. Lithium, beta-blockers, and antimalarials can be the most common causative drugs of psoriasis and also of rupioid type [6,7]. Various cases of treatment-induced psoriasis with ICIs (pembrolizumab, nivolumab) of different clinical types have been described in the literature, such as vulgaris [8], pustulate [9], linear [10], and arthropathy [11].…”

Section: Discussionmentioning

confidence: 99%

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Pembrolizumab-Induced Rupioid Psoriasis Treated by Apremilast Without Interrupting the Ongoing Antineoplastic Treatment

Ambrogio,

Rubino,

Laface

et al. 2024

Cureus

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We report the case of a 77-year-old man affected by a poorly differentiated metastatic pulmonary adenocarcinoma who, after the first course of therapy with cisplatin-pemetrexed-pembrolizumab treatment, developed rupioid psoriasis. We decided to discontinue pembrolizumab for four weeks until lesions improved and to start therapy with apremilast (an oral small molecule phosphodiesterase (PDE)4 inhibitor) in combination with systemic methylprednisolone 16 mg/day with consequent tapering until discontinuation in a few weeks.After accomplishing three months of treatment with apremilast, the patient gained complete remission of the rupioid lesions. Pembrolizumab therapy was reintroduced, and cycles were carried out without exacerbating the clinical picture. During the fourth month of therapy with apremilast, it was attempted to stop the treatment despite continuing the therapy with pembrolizumab. As a result, there was a relapse of the erythematous scaling plaques. After the subsequent reintroduction of apremilast, a new remission of the clinical picture occurred despite the absence of interruption of pembrolizumab. As far as we know, this is the second case of rupioid psoriasis induced by immunotherapy with pembrolizumab. Still, while the previous case was undergoing therapy with acitretin and methylprednisone, our patient is the first case treated with apremilast with excellent and rapid remission even after discontinuation and re-administration of pembrolizumab without exacerbation of dermatitis. In addition, the appearance of psoriasis during immunotherapy can be properly treated, which does not contraindicate the continuation of the antineoplastic treatment.

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