Clinical diagnosis and treatment in 1 case of exfoliative dermatitis caused by Pembrolizumab as well as cutaneous toxicity analysis of 44 cases treated with Pembrolizumab contemporaneously

doi:10.3969/j.issn.1004-583X.2022.02.011

Abstract

Abstract:

Objective Clinically, increasing immune-related adverse events cause concern with the promotion and application of immunotherapy. The tolerability profile could be effectively improved by controlling immune-related skin adverse reactions to enhance efficacy.Methods In this article regarding the diagnosis and treatment of severe immune-related adverse skin toxicity in a recent patient was reported. Meanwhile, a skin toxicity analysis were performed on 44 patients who received pembrolizumab in our hospital with a review of the related literature.Results Among 44 patients received pembrolizumab, only a few patients presented itchy skin and rash. The symptomatic treatment effect of hormone was good not affecting the continued use pembrolizumab. One case with severe exfoliative dermatitis withdrew immunotherapy although which resolved by active treatment.Conclusion Although the incidence of immune-related skin adverse reactions is low, it is essential to provide reasonable intervention theoretical basis and practical strategy regarding the diagnosis and treatment of immune-related adverse reactions.

Key words: immune checkpoint inhibitors, immune-related skin adverse reactions

CLC Number:

R979.5

Huang Jiayuan, Pan Banzhou, Ji Hong, Mei Jingfeng, Fan Zhaohui, Zhou Yun. Clinical diagnosis and treatment in 1 case of exfoliative dermatitis caused by Pembrolizumab as well as cutaneous toxicity analysis of 44 cases treated with Pembrolizumab contemporaneously[J]. Clinical Focus, 2022, 37(2): 150-154.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.02.011

https://huicui.hebmu.edu.cn/EN/Y2022/V37/I2/150

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References 19

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免疫相关性皮肤反应	例数	症状	治疗	转归
斑丘疹/皮疹
G1	2	斑疹/丘疹区域<10%全身体表面积(BSA),伴或不伴全身症状(例如:瘙痒、灼痛或紧绷)	复方曲安奈德乳膏、抗敏止痒水、氯雷他定片	好转,继续应用免疫治疗
G2	2	斑疹/丘疹区域占10%~30%全身BSA,伴或不伴全身症状(例如:瘙痒、灼痛或紧绷);日常使用工具受限	复方曲安奈德乳膏、抗敏止痒水、氯雷他定片和(或)泼尼松0.5~1 mg/(kg·d)	好转,继续应用免疫治疗
G3	0	斑疹/丘疹区域占>30%全身BSA,伴或不伴全身症状(例如:红斑、紫癜或表皮脱落);日常生活受限
瘙痒
G1	5	轻微或局限	硅油乳膏、复方曲安奈德乳膏、抗敏止痒水	好转,继续应用免疫治疗
G2	3	强烈或广泛;间歇性;抓挠致皮肤受损(如水肿、丘疹、脱屑、苔藓化、渗出/结痂);日常使用工具受限	硅油乳膏复方曲安奈德乳膏、抗敏止痒水、氯雷他定片和(或)泼尼松0.5~1 mg/(kg·d)	好转,继续应用免疫治疗
G3	0	强烈或广泛;持续性;日常生活自理明显受限或影响睡眠
大泡性皮炎/Stevens-Johnson综合征(SJS)/中毒性表皮坏死松解症(TEN)
G1	0	无症状,水疱区域<10%全身BSA,
G2	0	水疱覆盖占10%~30%伴疼痛;日常使用工具受限
G3	0	水疱覆盖BSA>30%,日常生活自理明显受限SJS或者TEN
G4	1	水疱覆盖BSA>30%;合并水电解质紊乱致死性SJS或者TEN	住院,起始甲基泼尼松龙2.7 mg/(kg·d)(后逐步减量),同时头孢曲松钠他唑巴坦钠抗感染,后加用氟康唑抗真菌,保持水电解质平衡,局部皮肤护理	好转,永久停用ICIs治疗

免疫相关性皮肤反应	例数	症状	治疗	转归
斑丘疹/皮疹
G1	2	斑疹/丘疹区域<10%全身体表面积(BSA),伴或不伴全身症状(例如:瘙痒、灼痛或紧绷)	复方曲安奈德乳膏、抗敏止痒水、氯雷他定片	好转,继续应用免疫治疗
G2	2	斑疹/丘疹区域占10%~30%全身BSA,伴或不伴全身症状(例如:瘙痒、灼痛或紧绷);日常使用工具受限	复方曲安奈德乳膏、抗敏止痒水、氯雷他定片和(或)泼尼松0.5~1 mg/(kg·d)	好转,继续应用免疫治疗
G3	0	斑疹/丘疹区域占>30%全身BSA,伴或不伴全身症状(例如:红斑、紫癜或表皮脱落);日常生活受限
瘙痒
G1	5	轻微或局限	硅油乳膏、复方曲安奈德乳膏、抗敏止痒水	好转,继续应用免疫治疗
G2	3	强烈或广泛;间歇性;抓挠致皮肤受损(如水肿、丘疹、脱屑、苔藓化、渗出/结痂);日常使用工具受限	硅油乳膏复方曲安奈德乳膏、抗敏止痒水、氯雷他定片和(或)泼尼松0.5~1 mg/(kg·d)	好转,继续应用免疫治疗
G3	0	强烈或广泛;持续性;日常生活自理明显受限或影响睡眠
大泡性皮炎/Stevens-Johnson综合征(SJS)/中毒性表皮坏死松解症(TEN)
G1	0	无症状,水疱区域<10%全身BSA,
G2	0	水疱覆盖占10%~30%伴疼痛;日常使用工具受限
G3	0	水疱覆盖BSA>30%,日常生活自理明显受限SJS或者TEN
G4	1	水疱覆盖BSA>30%;合并水电解质紊乱致死性SJS或者TEN	住院,起始甲基泼尼松龙2.7 mg/(kg·d)(后逐步减量),同时头孢曲松钠他唑巴坦钠抗感染,后加用氟康唑抗真菌,保持水电解质平衡,局部皮肤护理	好转,永久停用ICIs治疗