ABSTRACT
Antineoplastic agents that use the immune system have revolutionized cancer treatment. Specifically, implementation of immune checkpoint inhibitors, monoclonal antibodies that block cytotoxic T-lymphocyte-associated antigen-4, programmed cell death protein 1, or programmed cell death ligand 1 show improved and sustained responses in patients with cancer. However, these agents are associated with a plethora of adverse events, many manifesting in the skin. As the clinical application of cancer immunotherapies expands, understanding the clinical and histopathologic features of associated cutaneous toxicities becomes increasingly important to dermatologists, oncologists, and pathologists to ensure timely diagnosis and appropriate care. This review discusses cutaneous reactions to immune checkpoint inhibitors, focusing on histopathologic features.
Subject(s)
Drug Eruptions/etiology , Immune Checkpoint Inhibitors/adverse effects , Acantholysis/chemically induced , Acantholysis/pathology , Alopecia/chemically induced , Alopecia/pathology , Drug Eruptions/pathology , Humans , Keratinocytes/drug effects , Lichenoid Eruptions/chemically induced , Lichenoid Eruptions/pathology , Nevus, Pigmented/drug therapy , Panniculitis/chemically induced , Panniculitis/pathology , Pemphigoid, Bullous/chemically induced , Pemphigoid, Bullous/pathology , Pruritus/chemically induced , Pruritus/pathology , Psoriasis/chemically induced , Psoriasis/pathology , Stevens-Johnson Syndrome/etiology , Stevens-Johnson Syndrome/pathology , Vitiligo/chemically induced , Vitiligo/pathologyABSTRACT
Microorganisms inhabit various areas of the body, including the gut and skin, and are important in maintaining homeostasis. Changes to the normal microflora due to genetic or environmental factors can contribute to the development of various disease states. In this review, we will discuss the relationship between the gut and skin microbiome and various dermatological diseases including acne, psoriasis, rosacea, and atopic dermatitis. In addition, we will discuss the impact of treatment on the microbiome and the role of probiotics.
ABSTRACT
Eruptive actinic keratosis (AK) consequent to systemic chemotherapy can be confused with drug allergies. We present the first case of inflamed AKs in one patient after receiving combination therapy with pemetrexed and carboplatin.A 68-year-old woman with non-small cell lung adenocarcinoma (NSCLC) presented with numerous pruritic ill-defined, gritty, erythematous papules consistent with AKs on her upper chest, upper back, and arms two weeks after completing the first cycle of combination therapy with carboplatin and pemetrexed. The care team managed her with topical steroids and the lesions resolved within one month. The patient resumed the second cycle of chemotherapy and reported the occurrence of a similar but milder eruption.This case illustrates that eruptive AKs should be considered in the differential diagnosis of drug-related rashes, especially if the physical exam is suggestive. The mainstay of treatment should be directed at symptomatic improvement, and chemotherapy may be continued.
