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Rare case of Lichen Planus in patient on Pembrolizumab reported
Punjab: A recent case study published in Indian Dermatology Online Journal described developing a rare immune-related adverse side effect in a patient receiving pembrolizumab.
The case in question is of a 54-year-old female who developed pembrolizumab-induced lichen planus while receiving pembrolizumab to manage lung metastasis from squamous cell carcinoma of the buccal mucosa. The lichen planus responded to acitretin, and pembrolizumab was continued safely.
Pembrolizumab is the first anti-programmed death protein-1 agent approved by the US FDA (Food and Drug Administration). It has shown efficacy in lung cancer, melanoma, and other advanced solid tumours and hematologic malignancies. Several dermatological side effects include psoriasis, lichenoid skin reactions, vitiligo, maculopapular rash, pruritus, and rarely life-threatening conditions like bullous pemphigoid, drug rash with eosinophilia, Stevens-Johnson syndrome, and systemic symptoms have been reported.
The 54-year-old female presented with violaceous papules over the feet and mucosal lesions after the start of treatment with pembrolizumab after pulmonary metastasis detection on PET-CT. The consecutive scans conducted every six months revealed a constant regression of the underlying metastatic lesion with immunotherapy.
Pembrolizumab was continued in the patient after the development of lichenoid rash, which increased in severity in the form of ulcerations over soles and oral erosions. Acitretin helped to achieve remission in lichen planus, thus allowing pembrolizumab to be continued safely.
"Although none of the Indian studies has reported lichenoid reactions or lichen planus as a cutaneous adverse drug reaction due to pembrolizumab, lichen planus pemphigoid following pembrolizumab and nivolumab have been reported otherwise," Aditi Bansal, Deep Hospital, Ludhiana, Punjab, India, and colleagues wrote in their case report.
Dr. Bansal and the team reported, "Remission in lichen planus was achieved with acitretin, and pembrolizumab was continued safely for six months. Unfortunately, the patient succumbed to infection with COVID-19 in January 2022 during the third wave in India, as she had developed COVID-19 pneumonia.
"All the immune checkpoint inhibitors can induce dermatological adverse events, and with their rising use to manage malignancies, greater awareness is required among dermatologists to diagnose, manage, and report more such cases," the team concluded.
Reference:
Bansal, Aditi; Singla, Ankur1; Paul, Davinder2; Kaur, Sukhjot1. Pembrolizumab-Induced Lichen Planus: A Rare Immune-Related Adverse Side Effect. Indian Dermatology Online Journal 14(3):p 391-394, May–Jun 2023. | DOI: 10.4103/idoj.idoj_377_22
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751