By Ted Rosen, MD, FAAD, Editor-in-Chief
Acitretin for blockade-induced psoriasis
Immune checkpoint inhibitors (anti-PD-1 drugs) restore the anti-tumor actions of T-cells. However, by decreasing T-cell inhibition, these agents may then provoke a number of autoimmune disorders, including a worsening or induction of psoriasis. Stopping the immune checkpoint drug may be problematic, as treatment options may be limited. Should an anti-PD-1 drug provoke psoriasis, a suggested therapy is acitretin. Even at a relatively low dose (i.e., 20mg daily), acitretin may well vastly improve or even resolve immune checkpoint blockade-induced psoriasis without further perturbation of the immune system.
Isolated cases have also suggested apremilast and risankizumab as potential treatment options in this situation, but acitretin is certainly the easiest drug to institute and the easiest for which to obtain insurance coverage.
TO READ MORE: Killon L, et al. Nivolumab induced psoriasis successfully treated with acitretin. J Drugs Dermatol. 2021;20(8):911.
