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Updated: Feb 19, 2026
Identifying PD-1/PD-L1 Inhibitors with Surface Plasmon Resonance Technology
Published on: May 2, 2025
Anti-PD1/PDL1 induced psoriasis
Dimitra Voudouri1, Vasiliki Nikolaou1, Konstantinos Laschos2
1Dermato Oncology Department, Cutaneous Toxicities Clinic, Andreas Sygros Hospital, University of Athens, Athens, Greece.
Background:
Immune checkpoint inhibitors are novel agents approved for the treatment of late-stage malignancies. Despite its important clinical benefits, checkpoint inhibition is associated with a unique spectrum of side effects known as immune-related adverse events. Skin toxicities are the most frequent immune-related adverse events during anti-PD1 blockade therapies. Among them, rare cases of psoriasis exacerbation have been reported.
Methods:
We present the clinical characteristics of exacerbated psoriasis in 5 patients under anti-PD1/PDL1 therapy.
Results:
A total of 5 patients were overall included (4 males, 1 female mean age 65.8 years). Among them, 3 were diagnosed with nonsmall cell lung cancer, 1 with papillary urothelial carcinoma, and 1 with squamous cell carcinoma of the tonsil. Of all, 3 patients were treated with anti-PD1 (1 with pembrolizumab, 2 with nivolumab), whereas the remaining 2 with anti-PDL1 (durvalumab). Only 1 out of 5 patients had active psoriatic lesions at the time of treatment initiation, 2 shared a past history of psoriasis, and 1 reported a strong related family history (3/5 siblings). Four out of 5 patients experienced guttate lesions, though the most severe exacerbation was noted in the durvalumab group. Four out of 5 patients managed to continue treatment after close dermatologic monitoring, whereas 1 patient under durvalumab was forced to treatment delays owing to the severity of the skin reactions. Skin rashes appeared in all patients after the fourth cycle of immunotherapy.
Conclusions:
Both anti-PD1 and anti-PDL1 therapies can lead to psoriasis exacerbation although more severe flares were noted in patients treated with durvalumab. Not only personal but also related family history of psoriasis are significant risk factors and need to be outlined before treatment initiation. If such related history exists, strict skin surveillance can lead to the early diagnosis and treatment of any psoriatic exacerbations that could otherwise severely affect quality of life or even compromise therapeutic protocols and final prognosis.
Insights
Immune checkpoint inhibitors like anti-PD1/PDL1 therapies can trigger psoriasis flares. A family history of psoriasis increases risk, necessitating careful skin monitoring during cancer treatment.
Area of Science:
- Oncology
- Dermatology
- Immunology
Background:
- Immune checkpoint inhibitors (ICIs) are crucial for advanced cancers.
- Immune-related adverse events (irAEs) are common side effects of ICIs.
- Psoriasis exacerbation is a rare but reported irAE during anti-PD1 therapy.
Purpose of the Study:
- To describe clinical characteristics of psoriasis exacerbation in patients receiving anti-PD1/PDL1 therapy.
- To identify risk factors for psoriasis flares during ICI treatment.
Main Methods:
- Retrospective case series of 5 patients with psoriasis exacerbation.
- Patients were undergoing treatment with anti-PD1 or anti-PDL1 agents.
- Clinical data including history, lesion type, and treatment outcomes were analyzed.
Main Results:
- Five patients (4 male, 1 female; mean age 65.8) with various cancers experienced psoriasis exacerbation.
- Three patients received anti-PD1 (pembrolizumab, nivolumab) and two received anti-PDL1 (durvalumab).
- Psoriasis flares occurred after the fourth cycle; 4/5 had guttate lesions. One patient required treatment delay due to severe reaction. Family history was a significant factor.
Conclusions:
- Both anti-PD1 and anti-PDL1 therapies can induce psoriasis exacerbation, with durvalumab potentially causing more severe flares.
- Personal and family history of psoriasis are critical risk factors.
- Close dermatologic monitoring is essential for early diagnosis and management to maintain treatment protocols and patient prognosis.
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