Pembrolizumab-Induced Lichen Planus on the Scalp of a Patient with Non-Small-Cell Lung Carcinoma

A 67-year-old man with non-small-cell lung carcinoma was referred to our department because of a pruritic rash on his head and upper extremities. Prior to the development of the rash, he had received 4 cycles of combination therapy with pemetrexed, carboplatin, and pembrolizumab, followed by 2 cycle...

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Autores principales:	Aya Yamashita, Eijiro Akasaka, Hajime Nakano, Daisuke Sawamura
Formato:	article
Lenguaje:	EN
Publicado:	Karger Publishers 2021
Materias:	scalp pembrolizumab immune-related adverse effect immune checkpoint inhibitor lichen planus Dermatology RL1-803
Acceso en línea:	https://doaj.org/article/80064e6fd3b74e7d99960c815a21a119
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spelling	oai:doaj.org-article:80064e6fd3b74e7d99960c815a21a1192021-11-04T14:40:31ZPembrolizumab-Induced Lichen Planus on the Scalp of a Patient with Non-Small-Cell Lung Carcinoma1662-656710.1159/000519486https://doaj.org/article/80064e6fd3b74e7d99960c815a21a1192021-10-01T00:00:00Zhttps://www.karger.com/Article/FullText/519486https://doaj.org/toc/1662-6567A 67-year-old man with non-small-cell lung carcinoma was referred to our department because of a pruritic rash on his head and upper extremities. Prior to the development of the rash, he had received 4 cycles of combination therapy with pemetrexed, carboplatin, and pembrolizumab, followed by 2 cycles of pembrolizumab monotherapy. On physical examination, violaceous scaly erythema grouped on his scalp and upper extremities. Histologically, the scalp lesions demonstrated irregular acanthosis that formed a characteristic saw-tooth appearance with hypergranulosis and typical lichenoid tissue reaction. These findings suggested that the scalp lesions were lichen planus. Two-week administration of topical corticosteroid dramatically improved the rash. Immunotherapy with pembrolizumab, an anti-PD-1 antibody, can induce T-cell activation that results in various immune-related adverse effects such as lichenoid tissue reaction. However, lichen planus is generally found on the extremities and/or oral mucosa, and unlike in this case, the scalp is rarely affected. Although the exact mechanism underlying predominant scalp involvement is unknown, the present case indicates that anti-PD-1 therapy-induced lichen planus can develop not only on the extremities and oral mucosa but also on the scalp. Interestingly, the lesions were not induced by the combination of chemotherapy and pembrolizumab; rather, they occurred soon after initiation of pembrolizumab monotherapy. In the present case, pembrolizumab-induced T-cell activation which triggered lichenoid tissue reaction may have been suppressed by chemotherapy-induced immunosuppression. Dermatologists should have a thorough knowledge of the cutaneous lesions that manifest as irAEs of anti-PD-1 therapy.Aya YamashitaEijiro AkasakaHajime NakanoDaisuke SawamuraKarger Publishersarticlescalppembrolizumabimmune-related adverse effectimmune checkpoint inhibitorlichen planusDermatologyRL1-803ENCase Reports in Dermatology, Vol 13, Iss 3, Pp 487-491 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	scalp pembrolizumab immune-related adverse effect immune checkpoint inhibitor lichen planus Dermatology RL1-803
spellingShingle	scalp pembrolizumab immune-related adverse effect immune checkpoint inhibitor lichen planus Dermatology RL1-803 Aya Yamashita Eijiro Akasaka Hajime Nakano Daisuke Sawamura Pembrolizumab-Induced Lichen Planus on the Scalp of a Patient with Non-Small-Cell Lung Carcinoma
description	A 67-year-old man with non-small-cell lung carcinoma was referred to our department because of a pruritic rash on his head and upper extremities. Prior to the development of the rash, he had received 4 cycles of combination therapy with pemetrexed, carboplatin, and pembrolizumab, followed by 2 cycles of pembrolizumab monotherapy. On physical examination, violaceous scaly erythema grouped on his scalp and upper extremities. Histologically, the scalp lesions demonstrated irregular acanthosis that formed a characteristic saw-tooth appearance with hypergranulosis and typical lichenoid tissue reaction. These findings suggested that the scalp lesions were lichen planus. Two-week administration of topical corticosteroid dramatically improved the rash. Immunotherapy with pembrolizumab, an anti-PD-1 antibody, can induce T-cell activation that results in various immune-related adverse effects such as lichenoid tissue reaction. However, lichen planus is generally found on the extremities and/or oral mucosa, and unlike in this case, the scalp is rarely affected. Although the exact mechanism underlying predominant scalp involvement is unknown, the present case indicates that anti-PD-1 therapy-induced lichen planus can develop not only on the extremities and oral mucosa but also on the scalp. Interestingly, the lesions were not induced by the combination of chemotherapy and pembrolizumab; rather, they occurred soon after initiation of pembrolizumab monotherapy. In the present case, pembrolizumab-induced T-cell activation which triggered lichenoid tissue reaction may have been suppressed by chemotherapy-induced immunosuppression. Dermatologists should have a thorough knowledge of the cutaneous lesions that manifest as irAEs of anti-PD-1 therapy.
format	article
author	Aya Yamashita Eijiro Akasaka Hajime Nakano Daisuke Sawamura
author_facet	Aya Yamashita Eijiro Akasaka Hajime Nakano Daisuke Sawamura
author_sort	Aya Yamashita
title	Pembrolizumab-Induced Lichen Planus on the Scalp of a Patient with Non-Small-Cell Lung Carcinoma
title_short	Pembrolizumab-Induced Lichen Planus on the Scalp of a Patient with Non-Small-Cell Lung Carcinoma
title_full	Pembrolizumab-Induced Lichen Planus on the Scalp of a Patient with Non-Small-Cell Lung Carcinoma
title_fullStr	Pembrolizumab-Induced Lichen Planus on the Scalp of a Patient with Non-Small-Cell Lung Carcinoma
title_full_unstemmed	Pembrolizumab-Induced Lichen Planus on the Scalp of a Patient with Non-Small-Cell Lung Carcinoma
title_sort	pembrolizumab-induced lichen planus on the scalp of a patient with non-small-cell lung carcinoma
publisher	Karger Publishers
publishDate	2021
url	https://doaj.org/article/80064e6fd3b74e7d99960c815a21a119
work_keys_str_mv	AT ayayamashita pembrolizumabinducedlichenplanusonthescalpofapatientwithnonsmallcelllungcarcinoma AT eijiroakasaka pembrolizumabinducedlichenplanusonthescalpofapatientwithnonsmallcelllungcarcinoma AT hajimenakano pembrolizumabinducedlichenplanusonthescalpofapatientwithnonsmallcelllungcarcinoma AT daisukesawamura pembrolizumabinducedlichenplanusonthescalpofapatientwithnonsmallcelllungcarcinoma
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Pembrolizumab-Induced Lichen Planus on the Scalp of a Patient with Non-Small-Cell Lung Carcinoma

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