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- Presentation
Digging Deeper: Challenging Oncodermatoses
Description
In the session titled "Digging Deeper: Challenging Oncodermatoses," a dermatologist from Tufts Medical Center discusses rare cutaneous toxicities associated with PD1 inhibitors, focusing on case studies from their practice. The presentation highlights the mechanisms through which immunotherapy can lead to skin complications, such as lichen planus, bullous pemphigoid, and psoriasiform eruptions, emphasizing their potential for long-term implications even after treatment cessation. Three patient cases illustrate the complexities involved in diagnosing and managing these conditions, detailing the challenges of effectively balancing steroid use to manage symptoms while avoiding flare-ups, particularly in older patients with metastatic cancers. The speaker underscores the importance of recognizing and treating these skin manifestations promptly and the potential relationship between monoclonal gammopathy and neutrophilic dermatoses, calling for increased vigilance in monitoring for cutaneous infections among patients receiving immunotherapy. The discussion stresses that cutaneous effects of systemic immunotherapy can have significant long-term ramifications, indicating the necessity for a multidisciplinary approach to optimize patient care.
View moreConclusions
- There is a notable incidence of rare cutaneous toxicities associated with PD1 inhibitors, necessitating awareness in clinical practice.
- Lichen planus and bullous pemphigoid can develop in patients treated with immunotherapy, often complicating management decisions.
- Effective management of immunotherapy-related skin toxicities often requires a combination of systemic steroids and steroid-sparing agents like Dapsone or Apremilast.
- Autoimmune skin responses can occur even after discontinuation of immunotherapy, highlighting the need for long-term monitoring of cutaneous symptoms.
- Patients with pre-existing skin conditions such as psoriasis may experience exacerbated symptoms and new diagnoses following immunotherapy, indicating an immune reactivation process.
- Immunotherapy can compromise the skin barrier, leading to an increased risk of infections, which should be proactively monitored and managed.
- Monoclonal gammopathy may play a significant role in the pathophysiology of certain skin manifestations, warranting thorough investigation and management in affected patients.
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