Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep 23;2(1):ltac016.
doi: 10.1093/immadv/ltac016. eCollection 2022.

Prevalence of inverse psoriasis subtype with immune checkpoint inhibitors

Abdulhadi Jfri  1   2   3   4   5   6   7 , Bonnie Leung  3   8 , Jordan T Said  1   2   3 , Yevgeniy Semenov  1   8 , Nicole R LeBoeuf  1   2   3
Affiliations

Prevalence of inverse psoriasis subtype with immune checkpoint inhibitors

Abdulhadi Jfri et al. Immunother Adv. .

Abstract

Background: Cutaneous immune-related adverse events (irAEs) are the most common irAEs caused by immune-checkpoint inhibitors (ICI). Psoriasiform eruptions, both de novo and flares, may occur. Evidence is lacking on inverse psoriasis subtype.

Methods: A retrospective study was conducted at Dana-Farber Cancer Institute/Mass General Brigham through February 2020 using databases. Confirmed inverse psoriasis cases pre-/post-ICI initiation either independently or in conjunction with other psoriasis subtypes were included. Known psoriasis cases without flare post-ICI were excluded.

Results: A total of 262 (3%) individuals with any ICI-mediated psoriasiform cutaneous irAE were identified out of the 8683 DFCI ICI-treated patients. Of these, 13 (5% of psoriasis patients) had inverse psoriasis (mean age 68.7 years; 7/13 male sex). Median (range) time from ICI initiation to inverse psoriasis development or flare was 7 (4-12) and 3.5 (2-6) weeks, respectively. Pruritus occurred in 12/13 (92.30%) cases. 11 (85%) had inguinal involvement; other sites included gluteal cleft (6; 46%), inframammary (3; 23%), perianal (2; 15%), axilla (2; 15%), umbilicus (2; 15%), and infra-abdominal folds (1; 8%). Most (9/13) individuals had more than one site involved. The Common Terminology Criteria for Adverse Events severity was 1 in 10 (76.92%) individuals and 2 in 3 (15.38%) individuals. Six (46.15%) patients were treated initially by oncology with topical (nystatin, econazole, or clotrimazole) or systemic antifungals (fluconazole) for median (range) of 3.5 (1-7) months without improvement, for presumed candida intertrigo.

Conclusion: Patients on ICI may develop inverse psoriasis, which may be initially confused for fungal intertrigo. Delayed diagnosis can prolong symptoms, while patients are treated ineffectively with topical/systemic antifungals for presumed candida infection. Oncologist and dermatologist awareness is important to improve diagnosis of ICI-mediated inverse psoriasis, its management and affected patients' quality of life.

Keywords: flexural psoriasis; immune checkpoint inhibitors; immune-related adverse events; intertriginous psoriasis; inverse psoriasis; skin toxicity.

PubMed Disclaimer

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Inverse psoriasis. Well demarcated erythematous plaques involving axilla (a), inframammary (b), umbilicus (c), infra-abdominal folds (d), gluteal cleft and perianal (e), and inguinal (f).
Figure 2.
Figure 2.
Candida intertrigo (a) demonstrating satellite lesions vs. inverse psoriasis (b) that lacks satellite lesions.
See this image and copyright information in PMC

References

    1. Omland SH, Gniadecki R.. Psoriasis inversa: a separate identity or a variant of psoriasis vulgaris?. Clin Dermatol 2015; 33(4):456–61. 10.1016/j.clindermatol.2015.04.007 - DOI - PubMed
    1. Wang G, Li C, Gao Tet al. . Clinical analysis of 48 cases of inverse psoriasis: a hospital-based study. Eur J Dermatol 2005; 15(3):176–8. - PubMed
    1. Van de Kerkhof PCM, Murphy GM, Austad Jet al. . Psoriasis of the face and flexures. J Dermatolog Treat 2007; 18(6):351–60. 10.1080/09546630701341949 - DOI - PubMed
    1. Kato Y, Otsuka A, Miyachi Yet al. . Exacerbation of psoriasis vulgaris during nivolumab for oral mucosal melanoma. J Eur Acad Dermatol Venereol 2016; 30(10):e89–91. 10.1111/jdv.13336 - DOI - PubMed
    1. Matsumura N, Ohtsuka M, Kikuchi Net al. . Exacerbation of psoriasis during nivolumab therapy for metastatic melanoma. Acta Derm Venereol 2016; 96(2):259–60. 10.2340/00015555-2212 - DOI - PubMed

LinkOut - more resources