Checkpoint inhibitor–induced lichen planus differs from spontaneous lichen planus on the clinical, histological, and gene expression levelCapsule Summary

Barbara Meier-Schiesser, MD, PhD; Christine Zecha, MD; Sarah Zierold, MD; Isabel Kolm, MD; Magdalena Röckel, MD; Waltraud Fröhlich; Nora Mittag, MD; Christina Schmitt, MD; Joerg Kumbrink, PhD; Jessica C. Hassel, MD; Carola Berking, MD; Dorothee Nashan, MD; Lars Einar French, MD; Julio Vera-González, PhD; Reinhard Dummer, MD; Katrin Kerl-French, MD; Lucie Heinzerling, MD, MPH

JAAD International (Jun 2024)

Checkpoint inhibitor–induced lichen planus differs from spontaneous lichen planus on the clinical, histological, and gene expression levelCapsule Summary

Barbara Meier-Schiesser, MD, PhD,
Christine Zecha, MD,
Sarah Zierold, MD,
Isabel Kolm, MD,
Magdalena Röckel, MD,
Waltraud Fröhlich,
Nora Mittag, MD,
Christina Schmitt, MD,
Joerg Kumbrink, PhD,
Jessica C. Hassel, MD,
Carola Berking, MD,
Dorothee Nashan, MD,
Lars Einar French, MD,
Julio Vera-González, PhD,
Reinhard Dummer, MD,
Katrin Kerl-French, MD,
Lucie Heinzerling, MD, MPH

Affiliations

Barbara Meier-Schiesser, MD, PhD: Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
Christine Zecha, MD: Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
Sarah Zierold, MD: Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
Isabel Kolm, MD: Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
Magdalena Röckel, MD: Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
Waltraud Fröhlich: Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
Nora Mittag, MD: Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
Christina Schmitt, MD: Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
Joerg Kumbrink, PhD: Institute of Pathology, Faculty of Medicine, Ludwig Maximilian University Munich, Munich, Germany; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany
Jessica C. Hassel, MD: Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
Carola Berking, MD: Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
Dorothee Nashan, MD: Department of Dermatology, Hospital Dortmund, Dortmund, Germany
Lars Einar French, MD: Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany; Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida
Julio Vera-González, PhD: Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
Reinhard Dummer, MD: Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
Katrin Kerl-French, MD: Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
Lucie Heinzerling, MD, MPH: Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany; Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany; Correspondence to: Lucie Heinzerling, MD, MPH, Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Frauenlobstraße 9-11, 80337 Munich, Germany.

Journal volume & issue: Vol. 15
pp. 157 – 164

Abstract

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Background: Although highly efficacious, immune checkpoint inhibitors induce a multitude of immune-related adverse events including lichenoid skin reactions (irLP) that are often therapy-resistant. Objectives: To compare the clinical, histological, and transcriptional features of irLP with spontaneous lichen planus (LP). Methods: Clinical and histological presentations of irLP and LP, as well as the gene expression profiles of irLP and LP lesional and healthy skin were assessed. Results: irLP differed considerably from LP with regard to the distribution pattern of skin lesions with irLP appearing mostly in an exanthematous form, whereas lesions were more localized in the LP group. Histologically, dermal lymphocyte infiltration was significantly lower in irLP compared with LP, whereas lymphocyte exocytosis and apoptotic keratinocytes were significantly higher in irLP. Gene expression analysis revealed irLP to have a more inflammatory profile with elevated IFNG levels and a possible role of phagosome signaling compared with LP. Limitations: The study is descriptive and necessitates further investigation with larger cohorts and broader analyses. Conclusion: irLP differs from spontaneous LP on the clinical, histopathological, and gene expression level. The inflammatory gene signature in irLP suggests that topical JAK inhibitors could be an effective treatment, targeting local skin inflammation without systemic immunosuppression.

Published in JAAD International

ISSN: 2666-3287 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Dermatology
Website: https://www.journals.elsevier.com/jaad-international

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