title: PD-1 inhibitors induced bullous lichen planus-like reactions: a rare presentation and report of three cases.
abstract: The introduction of immunotherapy such as antiprogrammed death1 (anti-PD1) monoclonal antibodies has changed the scenario of treatment in cancer. Apart from their impressive efficacy profiles, they are better tolerated than the anticytotoxic T-lymphocyte-associated protein 4 antibodies. Dermatological adverse events such as pruritus and rash have been reported in various clinical trials. We report three cases of anti-PD1-induced bullous lichen planus (LP)-like reactions encountered in our institution. These patients developed LP-like papules and annular plaques with vesicles or crusted centres. Histology showed LP-like changes with negative immunofluorescence. Vesiculobullous lesions in patients treated with anti-PD1 therapies require a careful clinicopathological evaluation.
authors.affiliation: aDepartment of Dermatology, Westmead HospitalbSydney Medical School Westmead, The University of SydneyDepartments of cMedical OncologydTissue Pathology and Diagnostic Oncology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Deepal V
authors.initials: DV
authors.lastname: Wakade
authors.forename: Giuliana
authors.initials: G
authors.lastname: Carlos
authors.forename: Shelley J E
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Shaun
authors.initials: S
authors.lastname: Chou
authors.forename: Rina
authors.initials: R
authors.lastname: Hui
authors.forename: Pablo
authors.initials: P
authors.lastname: Fernandez-Peñas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008010:Lichen Planus / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D008545:Melanoma / Q000188:drug therapy* / Q000276:immunology; D008875:Middle Aged; D061026:Programmed Cell Death 1 Receptor / Q000037:antagonists & inhibitors* / Q000276:immunology; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000276:immunology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C105992:PDCD1 protein, human; D061026:Programmed Cell Death 1 Receptor; C582435:pembrolizumab