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Narrowband ultraviolet B therapy for refractory immune-related lichenoid dermatitis on PD-1 therapy: a case report
Khashayar Esfahani1, Meagan-Helen Henderson Berg2, Hanieh Zargham2
1Division of Oncology, Department of Medicine, McGill University, Montreal, Quebec, Canada khashayar.esfahani@mcgill.ca.
Abstract:
Treatment with programmed cell death 1 inhibitors is associated with a wide range of cutaneous immune-related adverse events, with lichenoid eruptions representing one of the major cutaneous toxicities. We describe the case of an 81-year-old man with metastatic melanoma treated with pembrolizumab who subsequently developed a delayed-onset generalized lichenoid dermatitis. After failing multiple lines of systemic immunosuppression, narrowband ultraviolet B (NBUVB) phototherapy three times per week for 17 sessions resulted in a significant clinical response in his cutaneous eruption and was well tolerated. NBUVB is a safe, lower-cost modality that induces local, skin-specific immunosuppression without the toxicities of traditional systemic immunosuppressive agents. To date, this is the first report of use of NBUVB in immune-related lichenoid dermatitis resistant to multiple standard therapies.
Insights
Programmed cell death 1 inhibitor therapy can cause skin issues like lichenoid dermatitis. Narrowband ultraviolet B (NBUVB) phototherapy effectively treated a patient’s drug-induced lichenoid dermatitis resistant to other treatments.
Area of Science:
- Dermatology
- Immunology
- Oncology
Background:
- Programmed cell death 1 (PD-1) inhibitors are crucial in cancer therapy but can trigger immune-related adverse events.
- Cutaneous immune-related adverse events are common, with lichenoid eruptions being a significant concern.
- Metastatic melanoma treatment with pembrolizumab poses a risk for these dermatologic toxicities.
Observation:
- An 81-year-old man with metastatic melanoma developed delayed-onset, generalized lichenoid dermatitis after pembrolizumab treatment.
- The patient's condition was refractory to multiple systemic immunosuppressive therapies.
- This case highlights a severe, treatment-resistant cutaneous manifestation of PD-1 inhibitor therapy.
Findings:
- Narrowband ultraviolet B (NBUVB) phototherapy was administered three times weekly for 17 sessions.
- NBUVB phototherapy led to a significant clinical improvement in the patient's lichenoid dermatitis.
- The treatment was well-tolerated, indicating a favorable safety profile.
Implications:
- NBUVB phototherapy presents a safe, cost-effective alternative for managing immune-related lichenoid dermatitis.
- This modality offers localized immunosuppression, avoiding systemic side effects.
- This is the first reported use of NBUVB for refractory immune-related lichenoid dermatitis, suggesting a new therapeutic avenue.
