@article{3119773,
    title = "Immune checkpoint-mediated psoriasis: A multicenter European study of 115 patients from the European Network for Cutaneous Adverse Event to Oncologic Drugs (ENCADO) group",
    author = "Nikolaou, V. and Sibaud, V. and Fattore, D. and Sollena, P. and Ortiz-Brugués, A. and Giacchero, D. and Romano, M.C. and Riganti, J. and Lallas, K. and Peris, K. and Voudouri, D. and Lallas, A. and Fabbrocini, G. and Lazaridou, E. and Carrera, C. and Annunziata, M.C. and Rossi, E. and Patri, A. and Rigopoulos, D. and Stratigos, A.J. and Apalla, Z.",
    journal = "Journal of the American Academy of Dermatology",
    year = "2021",
    volume = "84",
    number = "5",
    pages = "1310-1320",
    publisher = "Mosby Year Book Inc",
    issn = "0190-9622, 1097-6787",
    doi = "10.1016/j.jaad.2020.08.137",
    keywords = "adalimumab;  antineoplastic metal complex;  apremilast;  atezolizumab;  avelumab;  betamethasone;  bevacizumab;  cabozantinib;  calcipotriol;  capmatinib;  corticosteroid;  cyclosporine;  dabrafenib;  durvalumab;  etretin;  guselkumab;  immune checkpoint inhibitor;  infliximab;  ipilimumab;  methotrexate;  nivolumab;  pazopanib;  pembrolizumab;  prednisolone;  spartalizumab;  steroid;  tazarotene;  ustekinumab;  apremilast;  biological product;  dermatological agent;  etretin;  glucocorticoid;  thalidomide, adult;  aged;  algorithm;  Article;  body surface;  cancer chemotherapy;  cancer immunotherapy;  clinical feature;  cohort analysis;  combination drug therapy;  data analysis software;  disease exacerbation;  disease severity;  drug dose reduction;  drug withdrawal;  erythrodermic psoriasis;  female;  guttate psoriasis;  head and neck squamous cell carcinoma;  Hodgkin disease;  human;  lichen planus;  liver cell carcinoma;  lung cancer;  major clinical study;  male;  malignant neoplasm;  medical record review;  melanoma;  merkel cell carcinoma;  mesothelioma;  middle aged;  monotherapy;  nail psoriasis;  neuroendocrine tumor;  non small cell lung cancer;  ovary cancer;  priority journal;  pruritus;  psoriasis;  psoriasis vulgaris;  pustular psoriasis;  pustulosis palmoplantaris;  rash;  renal cell carcinoma;  retrospective study;  risk;  skin toxicity;  steroid therapy;  stomach cancer;  systemic disease;  systemic therapy;  topical treatment;  transitional cell carcinoma;  ultraviolet phototherapy;  vitiligo;  adverse event;  clinical trial;  Europe;  follow up;  immunology;  multicenter study;  neoplasm;  procedures;  psoriasis;  severity of illness index;  treatment outcome, Acitretin;  Aged;  Biological Products;  Dermatologic Agents;  Drug Therapy, Combination;  Europe;  Female;  Follow-Up Studies;  Glucocorticoids;  Humans;  Immune Checkpoint Inhibitors;  Male;  Methotrexate;  Middle Aged;  Neoplasms;  Psoriasis;  Retrospective Studies;  Severity of Illness Index;  Thalidomide;  Treatment Outcome",
    abstract = "Background: Immune checkpoint inhibitor (ICI)–mediated psoriasis poses significant diagnostic and therapeutic challenges. Objective: To report data on ICI-mediated psoriasis, emerging from the largest cohort to date, to our knowledge, and to propose a step-by-step management algorithm. Methods: The medical records of all patients with ICI-mediated psoriasis were retrospectively reviewed across 9 institutions. Results: We included a cohort of 115 individuals. Grade 1, 2, and 3 disease severity was reported in 60 of 105 (57.1%, 10 missing data), 34 of 105 (32.4%), and 11 of 105 (10.5%), respectively. The ratio between exacerbation and de novo cases was 1:4.3. The most common systemic therapy was acitretin (23 patients, 20.1%), followed by systemic steroids (8 patients, 7%), apremilast (7 patients, 6.1%), methotrexate (5 patients, 4.3%) and biologics (4 patients, 3.6%). Overall, 29 of 112 patients (25.9%) interrupted and 20 of 111 (18%) permanently discontinued ICIs because of psoriasis. Body surface area of greater than 10% at baseline had a 3.6 increased risk for ICI treatment modification (odds ratio, 3.64; 95% confidence interval, 1.27-10.45; P =.03) and a 6.4 increased risk for permanent discontinuation (odds ratio, 6.41; 95% confidence interval, 2.40-17.11; P <.001). Guttate psoriasis and grade 2 or 3 disease were significant positive predictors for antitumor response of ICI, whereas pruritus was a negative predictor. Limitations: Retrospective design. Conclusion: Acitretin, apremilast, and methotrexate are safe and effective modalities for ICI-mediated psoriasis. In most cases, ICI can be completed unhindered. A therapeutic algorithm is proposed. © 2020"
}