Abstract
Pityriasis lichenoides is a rare cutaneous disease that exists along a spectrum with acute and chronic features. The acute form, pityriasis lichenoides et varioliformis acuta (PLEVA), presents as a sudden onset scaly, erythematous, pruritic eruption while the chronic form, pityriasis lichenoides chronica, presents similarly but with a more indolent course. This inflammatory condition can have numerous triggers, including infections and medications. However, checkpoint inhibitors, despite being associated with a wide variety of cutaneous adverse events, have only rarely been associated with a pityriasis lichenoides-like eruption. We report a case of drug-induced pityriasis lichenoides-like eruption secondary to checkpoint inhibitor atezolizumab that was successfully treated with narrowband ultraviolet B (NBUVB) light. To our knowledge, this is the first case of an immune checkpoint inhibitor induced pityriasis lichenoides which responded well to NBUVB.
Highlights
Pityriasis lichenoides is a rare cutaneous disease, which exists along a spectrum with acute and chronic features.[1]
We report a case of atezolizumab induced pityriasis lichenoides, with both acute and chronic features, which cleared with narrowband ultraviolet B (NBUVB) phototherapy treatment
A drug-induced variant of pityriasis lichenoides was diagnosed secondary to atezolizumab. She was treated with topical clobetasol 0.05% ointment and oral prednisone initially dosed at 0.5 mg/kg with improvement of her skin lesions. Her systemic steroid course was held when she developed hypoxemic respiratory failure due to a parainfluenza pneumonia with concerns for a concurrent aspergillus pneumonia, for which she was started on Atezolizumab is a programmed death-ligand[1] (PD-L1) inhibitor approved for treatment of multiple cancers.[2]
Summary
Pityriasis lichenoides is a rare cutaneous disease, which exists along a spectrum with acute and chronic features.[1] The acute form, pityriasis lichenoides et varioliformis acuta (PLEVA), presents as an abrupt onset of pruritic, erythematous, scaly, often crusted, macules, papules and vesicles, on the trunk and extremities. Pityriasis lichenoides chronica (PLC) typically presents with a more indolent, scaling erythematous papular eruption. We report a case of atezolizumab induced pityriasis lichenoides, with both acute and chronic features, which cleared with narrowband ultraviolet B (NBUVB) phototherapy treatment
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