Neutrophilic dermatoses as adverse effects of checkpoint inhibitors: A review

Dermatol Ther. 2019 Sep;32(5):e13074. doi: 10.1111/dth.13074. Epub 2019 Sep 4.

Abstract

Checkpoint inhibitors are a new class of drugs that enhance the immune system's intrinsic ability to destroy tumor cells by blocking signaling through the programmed cell death (PD-1) receptor, its ligand (PD-L1), and the cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4). The resulting increase in immunologic activity is responsible for a variety of adverse cutaneous reactions, which sometimes include neutrophilic dermatoses. We queried the PubMed database for existing cases of checkpoint inhibitors causing neutrophilic dermatoses. The literature search identified four cases of Sweet syndrome, four cases of pustular eruptions, two cases of pyoderma gangrenosum, and one case of bullous lupus erythematosus secondary to checkpoint inhibitors. All neutrophilic dermatoses were treated with topical or systemic steroids and most (9 of 11) completely resolved. Dermatologists should be aware of these rare, adverse cutaneous reactions to checkpoint inhibitors and how to approach their treatment, especially as their use increases.

Keywords: ipilimumab; neutrophilic dermatosis; nivolumab.

Publication types

  • Review

MeSH terms

  • Administration, Topical
  • Adrenal Cortex Hormones / administration & dosage
  • Checkpoint Kinase 1 / antagonists & inhibitors*
  • Drug Eruptions / drug therapy
  • Drug Eruptions / etiology*
  • Female
  • Humans
  • Leukocyte Count
  • Male
  • Melanoma / drug therapy*
  • Melanoma / pathology
  • Neutrophils / cytology
  • Prognosis
  • Protein Kinase Inhibitors / adverse effects*
  • Protein Kinase Inhibitors / therapeutic use
  • Risk Assessment
  • Skin Neoplasms / drug therapy*
  • Skin Neoplasms / pathology

Substances

  • Adrenal Cortex Hormones
  • Protein Kinase Inhibitors
  • Checkpoint Kinase 1