Treatment of PD-1/PD-L1 Inhibitor–Induced Dermatitis Resolves Concomitant Eruptive Keratoacanthomas

Successful treatment of eruptive keratoacanthomas with actitretin for patients on checkpoint inhibitor immunotherapy

“…This contrasts with previous reports in which interruption of immunotherapy treatment was required due to EK progression. 3,5,6 Acitretin has antineoplastic properties and anti-inflammatory effects, which have been thoroughly demonstrated in previous studies. 7,8 Although the mechanism of action of retinoids on KA is not fully understood, some have suggested that its modulation on differentiation of keratinocytes may have an inhibitory effect over the keratinization process of KA.…”

“…This observation has been noted in previous reports, which have hypothesized that EKs in immunotherapy patients represent an inflammatory rather than a neoplastic phenomenon. 5 Regarding treatment, the initial daily dose of acitretin was 10 mg (4/7), 20 mg (2/7) or 25 mg (1/7) with a higher dose in patients with more extensive disease. The dosage was increased in three cases, to a maximum of 50 mg, to achieve an adequate response.…”

A clinical and biological review of keratoacanthoma*

“…Anti-inflammatory treatments, including hydroxychloroquine and topical steroids, led to resolution of both the underlying dermatitis and KAs in these patients. 148 Prolonged immunosuppression greatly increases the risk of developing cSCC, but the risk is not as clear with KA. 17 T-cell immune surveillance against commensal beta HPV suppresses cSCC in immunocompetent individuals, which is substantially blunted in immunosuppressed patients.…”

Goeckerman Regimen as an Effective Treatment Modality for Checkpoint Inhibitor Dermatoses

“…Based on the safety and efficacy of the therapy, the Goeckerman regimen is an excellent treatment modality for any patient with moderate to severe psoriasis, eczema, and other severe pruritic and/or inflammatory skin conditions 3 . One case report has even successfully documented the Goeckerman regimen in the treatment of eruptive keratoacanthomas and lichenoid dermatitis due to pembrolizumab 4 . Goeckerman therapy, to the authors' knowledge, has never been reported as treating BP and a psoriasiform dermatitis due to an immune checkpoint inhibitor.…”