Adriana T. Lopez

A review of bullous pemphigoid associated with PD‐1 and PD‐L1 inhibitors

Dermatologic toxicity represents a substantial portion of all immune‐related adverse events (irAEs) associated with PD‐1/PD‐L1 inhibitors. Bullous pemphigoid (BP) is a rare cutaneous side effect of these medications, which can initially be clinically indistinguishable from other, low‐grade cutaneous toxicity.

Nab-paclitaxel/Gemcitabine Induced Acquired Ichthyosis

The ichthyoses are a diverse group of cutaneous disorders characterized by abnormalities in cornification. The majority of ichthyoses are inherited with childhood presentation and new onset ichthyosis in adulthood warrants further medical evaluation. Though most well recognized for its association with Hodgkin’s disease, acquired ichthyosis (AI) has been linked to a number of inflammatory, autoimmune, and endocrine processes. However, drug induced AI is exceedingly rare and remains a poorly understood entity. Here we report the case of man with who developed AI while receiving nab-paclitaxel plus gemcitabine for treatment of pancreatic adenocarcinoma and review the literature.

A Case of Nivolumab‐Induced Bullous Pemphigoid: Review of Dermatologic Toxicity Associated with Programmed Cell Death Protein‐1/Programmed Death Ligand‐1 Inhibitors and Recommendations for Diagnosis and Management

Bullous pemphigoid is an autoimmune subepidermal blistering disease characterized by the development of tense bullae and is most frequently seen in the elderly. PD‐1/PD‐L1‐induced bullous pemphigoid (BP) has emerged as a potentially serious dermatologic toxicity. This article reports a case of a 72‐year‐old woman who developed BP shortly after initiating treatment with the PD‐1 inhibitor nivolumab for metastatic non‐small cell lung cancer.

Programmed cell death protein-1 inhibitor–induced granuloma annulare and hypertrophic lichen planus masquerading as squamous cell carcinoma

Pembrolizumab is a humanized monoclonal antibody against programmed cell death protein-1 (PD-1) and is an effective treatment for advanced non–small cell lung cancer1 and advanced melanoma.2 PD-1 functions as a checkpoint of the effector stage of the immune system and inactivates T cells when they reach tumors.2 n nSystemic adverse events of checkpoint inhibitors include fatigue, fever, chills, and infusion reactions. Skin rash is the most common immune-related adverse event associated with checkpoint monoclonal antibody therapy, which can manifest as maculopapular rash, urticarial dermatitis, lichenoid dermatitis, bullous pemphigoid, Stevens-Johnson syndrome, and toxic epidermal necrolysis.2, 3 n nWe report a case of hypertrophic lichen planus (HLP) mimicking squamous cell carcinoma (SCC) as well as granuloma annulare (GA) associated with pembrolizumab.

Successful treatment of drug reaction with eosinophilia and systemic symptoms syndrome relapse with oral pulsed dexamethasone

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe hypersensitivity reaction that can be life threatening. Long-term treatment with corticosteroids is required in the management of DRESS syndrome, and relapse or worsening of symptoms after a short course of steroids after initial improvement is common. Oral steroid pulse therapy has been used to treat various dermatologic conditions with the goal of reducing toxicity associated with sustained steroid use. The use of oral pulse therapy in the treatment of DRESS syndrome has not been reported. Here we present the case of a patient with allopurinol-induced DRESS syndrome relapse successfully treated with pulsed oral dexamethasone.

Nevus anemicus: An island of sparing in the setting of drug-induced hypersensitivity

DIHS: drug-induced hypersensitivity syndrome HHV-6: human herpes 6 virus NA: nevus anemicus NDP: nevus depigmentosus INTRODUCTION Nevus anemicus (NA) is an uncommon congenital finding characterized by a discrete area of hypopigmentation that remains stable in size throughout life. To our knowledge, generalized cutaneous eruption sparing NA in a mosaic fashion has never been reported in the literature. We report a case of erythrodermic drug-induced hypersensitivity syndrome (DIHS) in the setting of human herpes 6 virus (HHV-6) viremia, sparing NA.

The Role of Oncolytic Viruses in the Treatment of Melanoma

Purpose of ReviewOncolytic virotherapy is a new approach to the treatment of cancer and its success in the treatment of melanoma represents a breakthrough in cancer therapeutics. This paper provides a review of the current literature on the use of oncolytic viruses (OVs) in the treatment of melanoma.Recent FindingsTalimogene laherparepvec (T-VEC) is the first OV approved for the treatment of melanoma and presents new challenges as it enters the clinical setting. Several other OVs are at various stages of clinical and pre-clinical development for the treatment of melanoma. Reports from phase Ib-III clinical trials combining T-VEC with checkpoint blockade are encouraging and demonstrate potential added benefit of combination immunotherapy.SummaryOVs have recently emerged as a standard treatment option for patients with advanced melanoma. Several OVs and therapeutic combinations are in development. Immunooncolytic virotherapy combined with immune checkpoint inhibitors is promising for the treatment of advanced melanoma.

Current Status of HDAC Inhibitors in Cutaneous T-cell Lymphoma

Cutaneous T-cell lymphomas (CTCLs) are a heterogeneous group of lymphomas that are characterized by primary skin involvement. Mycosis fungoides (MF) and Sézary syndrome (SS), the two most common subtypes of CTCL, can be difficult to manage clinically as there are few effective treatment options available. Recently, histone deacetylase inhibitors (HDACi) have emerged as promising therapies with favorable adverse effect profiles, compared with traditional chemotherapies. In this article, we review the published literature to evaluate the role of HDACi in the treatment of CTCL. Specifically, we (1) briefly discuss the molecular rationale for the use of HDACi in CTCL; (2) compare the efficacy, tolerability, and adverse effects of HDACi; (3) review the cardiac safety data; and (4) discuss optimization of therapy with HDACi in the treatment of CTCL.

Facial calcinosis cutis in a patient with systemic lupus erythematosus: A case report of tissue injury owing to photosensitivity as the cause of dystrophic calcification

SLE: systemic lupus erythematosus INTRODUCTION Soft tissue calcification (calcinosis cutis) is a rare disorder with 5 different subtypes: dystrophic, metastatic, idiopathic, iatrogenic, and calciphylaxis. Dystrophic calcinosis refers to the deposition of calcium in areas of prior tissue injury in patients with normal serum calcium and phosphorus. Dystrophic calcification has been associated with various connective tissue disorders including dermatomyositis, overlap syndrome, diffuse cutaneous systemic sclerosis, and CREST (calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome; however, it is rarely seen in systemic lupus erythematosus (SLE). We report a unique case of bilateral preauricular platelike calcification in a 25-year-old woman with a 4-year history of SLE. We hypothesize that repeated tissue trauma secondary to photosensitivity was the cause of facial dystrophic calcification. To our knowledge, there are no documented cases of facial calcinosis in association with SLE.