array:23 [
  "pii" => "S0365059623001873"
  "issn" => "03650596"
  "doi" => "10.1016/j.abd.2023.02.003"
  "estado" => "S300"
  "fechaPublicacion" => "2024-01-01"
  "aid" => "821"
  "copyright" => "Sociedade Brasileira de Dermatologia"
  "copyrightAnyo" => "2023"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "pt" => array:18 [
      "pii" => "S2666275223002175"
      "issn" => "26662752"
      "doi" => "10.1016/j.abdp.2023.08.006"
      "estado" => "S300"
      "fechaPublicacion" => "2024-01-01"
      "aid" => "821"
      "copyright" => "Sociedade Brasileira de Dermatologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "pt" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Cartas &#8208; Terapia</span>"
        "titulo" => "Psor&#237;ase pustulosa desencadeada ap&#243;s terap&#234;utica com atezolizumabe e bevacizumabe"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "153"
            "paginaFinal" => "155"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0015"
            "etiqueta" => "Figura 3"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr3.jpeg"
                "Alto" => 1670
                "Ancho" => 2508
                "Tamanyo" => 926085
              ]
            ]
            "descripcion" => array:1 [
              "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Presen&#231;a de les&#245;es pustulosas generalizadas em tronco&#46; &#40;B&#41; Exame anatomopatol&#243;gico demonstrou p&#250;stulas intraepid&#233;rmicas&#44; subc&#243;rneas e infiltrado psoriasiforme &#40;Hematoxilina &#38; eosina&#44; 100<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Mariani Magnus da Luz Andrade, Guilherme Ladwig Tejada, Juliano Peruzzo, Renan Rangel Bonamigo"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Mariani Magnus da Luz"
                "apellidos" => "Andrade"
              ]
              1 => array:2 [
                "nombre" => "Guilherme Ladwig"
                "apellidos" => "Tejada"
              ]
              2 => array:2 [
                "nombre" => "Juliano"
                "apellidos" => "Peruzzo"
              ]
              3 => array:2 [
                "nombre" => "Renan Rangel"
                "apellidos" => "Bonamigo"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0365059623001873"
          "doi" => "10.1016/j.abd.2023.02.003"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623001873?idApp=UINPBA00008Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223002175?idApp=UINPBA00008Z"
      "url" => "/26662752/0000009900000001/v1_202401040746/S2666275223002175/v1_202401040746/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S0365059623002052"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2022.05.013"
    "estado" => "S300"
    "fechaPublicacion" => "2024-01-01"
    "aid" => "845"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter - Therapy</span>"
      "titulo" => "Successful treatment of erythrodermic pemphigus foliaceus with intravenous immunoglobulin"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "156"
          "paginaFinal" => "158"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 1708
              "Ancho" => 2175
              "Tamanyo" => 312749
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0015"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Desquamation of the entire face before treatment&#46; &#40;B&#41; Complete resolution with therapy</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Hiram Larangeira de Almeida, Junior Wieczorek, Mahony Santana, Celina Leite"
          "autores" => array:4 [
            0 => array:3 [
              "nombre" => "Hiram Larangeira de"
              "apellidos" => "Almeida"
              "sufijo" => "Jr&#46;"
            ]
            1 => array:2 [
              "nombre" => "Junior"
              "apellidos" => "Wieczorek"
            ]
            2 => array:2 [
              "nombre" => "Mahony"
              "apellidos" => "Santana"
            ]
            3 => array:2 [
              "nombre" => "Celina"
              "apellidos" => "Leite"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275223002424"
        "doi" => "10.1016/j.abdp.2023.09.023"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223002424?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623002052?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009900000001/v1_202401040817/S0365059623002052/v1_202401040817/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S0365059623001988"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2022.05.011"
    "estado" => "S300"
    "fechaPublicacion" => "2024-01-01"
    "aid" => "833"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter - Therapy</span>"
      "titulo" => "Complete resolution of generalized annular elastolytic giant cell granuloma with doxycycline"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "150"
          "paginaFinal" => "153"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1753
              "Ancho" => 3175
              "Tamanyo" => 780040
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0005"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Multiple erythematous annular plaques on the back and posterior neck at the initial visit&#46; &#40;B&#41; Complete resolution of the lesions after 5 months under treatment with doxycycline 100&#8239;mg&#47;day</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "D&#237;dac Mar&#237;n-Pi&#241;ero, M&#46; &#193;ngeles Sola-Casas, Noelia Perez-Mu&#241;oz"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "D&#237;dac"
              "apellidos" => "Mar&#237;n-Pi&#241;ero"
            ]
            1 => array:2 [
              "nombre" => "M&#46; &#193;ngeles"
              "apellidos" => "Sola-Casas"
            ]
            2 => array:2 [
              "nombre" => "Noelia"
              "apellidos" => "Perez-Mu&#241;oz"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275223002291"
        "doi" => "10.1016/j.abdp.2023.09.011"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223002291?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623001988?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009900000001/v1_202401040817/S0365059623001988/v1_202401040817/en/main.assets"
  ]
  "en" => array:17 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter - Therapy</span>"
    "titulo" => "Pustular psoriasis triggered by therapy with atezolizumab and bevacizumab"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#44;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "153"
        "paginaFinal" => "155"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Mariani Magnus da Luz Andrade, Guilherme Ladwig Tejada, Juliano Peruzzo, Renan Rangel Bonamigo"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Mariani Magnus da Luz"
            "apellidos" => "Andrade"
            "email" => array:1 [
              0 => "mmdandrade@hcpa.edu.br"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Guilherme Ladwig"
            "apellidos" => "Tejada"
          ]
          2 => array:2 [
            "nombre" => "Juliano"
            "apellidos" => "Peruzzo"
          ]
          3 => array:2 [
            "nombre" => "Renan Rangel"
            "apellidos" => "Bonamigo"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Hospital de Cl&#237;nicas de Porto Alegre&#44; Porto Alegre&#44; RS&#44; Brazil"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1670
            "Ancho" => 2508
            "Tamanyo" => 927762
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0400"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Presence of generalized pustular lesions on the trunk&#59; &#40;B&#41; Anatomopathological examination showed intraepidermal subcorneal pustules and psoriasiform infiltrate &#40;Hematoxylin &#38; eosin&#44; &#215;100&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Atezolizumab &#40;ATZ&#41; and Bevacizumab &#40;BVZ&#41; are used in the immunotherapy of some advanced tumors&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> ATZ is an immune checkpoint inhibitor&#44; an antagonist of PDL1&#44; expressed in tumor cells&#44; which allows both the evasion of these cells from the immune system&#44; as well as a reduction in T-cell proliferation&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This class of drugs can cause a variety of cutaneous adverse effects&#44; mainly immune-mediated&#44; such as neutrophilic&#44; bullous dermatoses&#44; and vitiligo&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> BVZ is an anti-VEGF&#44; therefore with anti-angiogenic action&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and cutaneous side effects such as exanthema and impaired tissue healing have also been described&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The authors present a rare cutaneous adverse event&#44; pustular psoriasis&#44; after the start of the aforementioned therapeutic combination&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A 55-year-old male patient with a history of mild psoriasis controlled only with topical treatment&#44; presented with erythematous&#44; desquamative plaques with pustules on the dorsum of the hands&#44; elbows&#44; legs&#44; and feet after starting ATZ<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>BVZ therapy for hepatocellular carcinoma&#46; These medications were administered every 21 days and were infused on the same day&#46; During follow-up&#44; the infusion was withdrawn due to hospitalization because of clinical complications&#46; At the time&#44; there was rapid improvement of the lesions&#44; in four weeks &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; After this period&#44; the infusions were resumed&#44; and psoriasis recurred &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#44; reinforcing the association between the skin condition and drug administration&#46; The clinical presentation&#44; in the form of erythematous-desquamative plaques with pustules &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figs&#46; 2</a>A and <a class="elsevierStyleCrossRef" href="#fig0010">2</a> B&#41; and pustule generalization to the trunk &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A&#41;&#44; associated with the anatomopathological examination &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>B&#41; with intraepidermal pustules and psoriasiform infiltrate&#44; allowed the diagnosis of psoriatic exacerbation&#44; in the form of pustular psoriasis&#44; triggered by antineoplastic immunotherapy&#46; The case constituted a therapeutic challenge since the patient had an hepatocellular carcinoma developed in cirrhosis due to chronic hepatitis C&#46; Therefore&#44; there was contraindication to the use of drugs such as acitretin and methotrexate&#44; due to the risk of severe liver toxicity &#40;including liver failure&#41;&#44; and to the use of anti-TNF&#44; considering the diagnosis of hepatitis C&#46; Moreover&#44; the patient developed arthritis in the interphalangeal joints&#44; reinforcing the choice of systemic therapy&#46; Considering these limitations&#44; the authors chose an interleukin &#40;IL-&#41; inhibitor&#44; ustekinumab &#40;anti-IL 12&#47;23&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Interestingly&#44; there have been reports of psoriasis improvement with the use of BVZ&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> Vascular proliferation in the papillary dermis is known to play an important role in the pathophysiology of psoriasis&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Moreover&#44; it was found that VEGF levels are higher in psoriatic lesions when compared to healthy skin&#46; Plasma factor levels have also been observed to be higher in patients with psoriasis than in healthy ones&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">On the other hand&#44; ATZ seems to induce a pro-inflammatory state&#44; with a change in the cytokine profile&#44; with an increase in TNF-&#945; and IL-17 levels&#44; which would explain psoriasis onset or worsening&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Skin changes due to ATZ usually occur within five to nine weeks after beginning therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In the present case&#44; psoriasis worsening occurred nine weeks after starting therapy&#44; in agreement with the literature&#46; Guttate&#44; inverse&#44; and palmoplantar presentations of psoriasis exacerbations have been described with the use of ATZ&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Therefore&#44; the case highlights the combination related to the eruption&#44; and also the unusual pustular presentation&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Mariani Magnus Andrade&#58; Collection&#44; analysis and interpretation of data&#59; drafting and editing of the manuscript or critical review of important intellectual content&#59; critical review of the literature&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Guilherme Ladwig Tejada&#58; Collection&#44; analysis and interpretation of data&#59; drafting and editing of the manuscript or critical review of important intellectual content&#59; critical review of the literature&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Juliano Peruzzo&#58; Analysis and interpretation of data&#59; critical review of important intellectual content&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Renan Rangel Bonamigo&#58; Analysis and interpretation of data&#59; critical review of important intellectual content&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:4 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Financial support"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Authors&#39; contributions"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Conflicts of interest"
        ]
        3 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2022-12-19"
    "fechaAceptado" => "2023-02-02"
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Hospital de Cl&#237;nicas de Porto Alegre&#44; Porto Alegre&#44; RS&#44; Brazil&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1990
            "Ancho" => 2508
            "Tamanyo" => 559926
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0390"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Patient showing improvement of psoriasis lesions after withdrawal of atezolizumab and bevacizumab infusion&#59; &#40;B&#41; Patient showed recurrence of psoriatic lesions after a new infusion&#44; as erythematous-desquamative plaques with pustules&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1674
            "Ancho" => 2508
            "Tamanyo" => 721260
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0395"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Detail of the clinical lesions on the legs&#44; showing erythematous-desquamative plaques with pustules&#59; &#40;B&#41; Dermoscopy showing the pustules&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1670
            "Ancho" => 2508
            "Tamanyo" => 927762
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0400"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Presence of generalized pustular lesions on the trunk&#59; &#40;B&#41; Anatomopathological examination showed intraepidermal subcorneal pustules and psoriasiform infiltrate &#40;Hematoxylin &#38; eosin&#44; &#215;100&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dermatologic toxicities to immune checkpoint inhibitor therapy&#58; a review of histopathologic features"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;R&#46; Ellis"
                            1 => "A&#46;T&#46; Vierra"
                            2 => "J&#46;W&#46; Millsop"
                            3 => "M&#46;E&#46; Lacouture"
                            4 => "M&#46; Kiuru"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2020.04.105"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "2020"
                        "volumen" => "83"
                        "paginaInicial" => "1130"
                        "paginaFinal" => "1143"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32360716"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vascular endothelial growth factor-A as a promising therapeutic target for the management of psoriasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Luengas-Martinez"
                            1 => "J&#46; Hardman-Smart"
                            2 => "R&#46; Paus"
                            3 => "H&#46;S&#46; Young"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Exp Dermatol&#46;"
                        "fecha" => "2020"
                        "volumen" => "29"
                        "paginaInicial" => "687"
                        "paginaFinal" => "698"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Understanding and managing the possible adverse effects associated with bevacizumab"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;S&#46; Shord"
                            1 => "L&#46;R&#46; Bressler"
                            2 => "L&#46;A&#46; Tierney"
                            3 => "S&#46; Cuellar"
                            4 => "A&#46; George"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2146/ajhp080455"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Health Syst Pharm&#46;"
                        "fecha" => "2009"
                        "volumen" => "66"
                        "paginaInicial" => "999"
                        "paginaFinal" => "1013"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19451611"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complete remission of psoriasis following bevacizumab therapy for colon cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Akman"
                            1 => "E&#46; Yilmaz"
                            2 => "H&#46; Mutlu"
                            3 => "M&#46; Ozdogan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2230.2008.02991.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Exp Dermatol&#46;"
                        "fecha" => "2009"
                        "volumen" => "34"
                        "paginaInicial" => "e202"
                        "paginaFinal" => "e204"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19077094"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0025619618307079"
                          "estado" => "S300"
                          "issn" => "00256196"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Remission of psoriasis and psoriatic arthritis during bevacizumab therapy for renal cell c&#226;ncer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Datta-Mitra"
                            1 => "N&#46;K&#46; Riar"
                            2 => "S&#46;P&#46; Raychaudhuri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0019-5154.143578"
                      "Revista" => array:5 [
                        "tituloSerie" => "Indian J Dermatol&#46;"
                        "fecha" => "2014"
                        "volumen" => "59"
                        "paginaInicial" => "632"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25484422"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/03650596/0000009900000001/v1_202401040817/S0365059623001873/v1_202401040817/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "96904"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letter &#8211; Therapy"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009900000001/v1_202401040817/S0365059623001873/v1_202401040817/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623001873?idApp=UINPBA00008Z"
]
Share
Journal Information
Vol. 99. Issue 1.
Pages 153-155 (1 January 2024)
Visits
3661
Vol. 99. Issue 1.
Pages 153-155 (1 January 2024)
Letter - Therapy
Full text access
Pustular psoriasis triggered by therapy with atezolizumab and bevacizumab
Visits
3661
Mariani Magnus da Luz Andrade
Corresponding author
mmdandrade@hcpa.edu.br

Corresponding author.
, Guilherme Ladwig Tejada, Juliano Peruzzo, Renan Rangel Bonamigo
Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (3)
Show moreShow less
Full Text
Dear Editor,

Atezolizumab (ATZ) and Bevacizumab (BVZ) are used in the immunotherapy of some advanced tumors.1,2 ATZ is an immune checkpoint inhibitor, an antagonist of PDL1, expressed in tumor cells, which allows both the evasion of these cells from the immune system, as well as a reduction in T-cell proliferation.1 This class of drugs can cause a variety of cutaneous adverse effects, mainly immune-mediated, such as neutrophilic, bullous dermatoses, and vitiligo.1 BVZ is an anti-VEGF, therefore with anti-angiogenic action,2 and cutaneous side effects such as exanthema and impaired tissue healing have also been described.3

The authors present a rare cutaneous adverse event, pustular psoriasis, after the start of the aforementioned therapeutic combination.

A 55-year-old male patient with a history of mild psoriasis controlled only with topical treatment, presented with erythematous, desquamative plaques with pustules on the dorsum of the hands, elbows, legs, and feet after starting ATZ+BVZ therapy for hepatocellular carcinoma. These medications were administered every 21 days and were infused on the same day. During follow-up, the infusion was withdrawn due to hospitalization because of clinical complications. At the time, there was rapid improvement of the lesions, in four weeks (Fig. 1A). After this period, the infusions were resumed, and psoriasis recurred (Fig. 1B), reinforcing the association between the skin condition and drug administration. The clinical presentation, in the form of erythematous-desquamative plaques with pustules (Figs. 2A and 2 B) and pustule generalization to the trunk (Fig. 3A), associated with the anatomopathological examination (Fig. 3B) with intraepidermal pustules and psoriasiform infiltrate, allowed the diagnosis of psoriatic exacerbation, in the form of pustular psoriasis, triggered by antineoplastic immunotherapy. The case constituted a therapeutic challenge since the patient had an hepatocellular carcinoma developed in cirrhosis due to chronic hepatitis C. Therefore, there was contraindication to the use of drugs such as acitretin and methotrexate, due to the risk of severe liver toxicity (including liver failure), and to the use of anti-TNF, considering the diagnosis of hepatitis C. Moreover, the patient developed arthritis in the interphalangeal joints, reinforcing the choice of systemic therapy. Considering these limitations, the authors chose an interleukin (IL-) inhibitor, ustekinumab (anti-IL 12/23).

Figure 1.

(A) Patient showing improvement of psoriasis lesions after withdrawal of atezolizumab and bevacizumab infusion; (B) Patient showed recurrence of psoriatic lesions after a new infusion, as erythematous-desquamative plaques with pustules.

(0.53MB).
Figure 2.

(A) Detail of the clinical lesions on the legs, showing erythematous-desquamative plaques with pustules; (B) Dermoscopy showing the pustules.

(0.69MB).
Figure 3.

(A) Presence of generalized pustular lesions on the trunk; (B) Anatomopathological examination showed intraepidermal subcorneal pustules and psoriasiform infiltrate (Hematoxylin & eosin, ×100).

(0.88MB).

Interestingly, there have been reports of psoriasis improvement with the use of BVZ.4,5 Vascular proliferation in the papillary dermis is known to play an important role in the pathophysiology of psoriasis.2 Moreover, it was found that VEGF levels are higher in psoriatic lesions when compared to healthy skin. Plasma factor levels have also been observed to be higher in patients with psoriasis than in healthy ones.2

On the other hand, ATZ seems to induce a pro-inflammatory state, with a change in the cytokine profile, with an increase in TNF-α and IL-17 levels, which would explain psoriasis onset or worsening.1 Skin changes due to ATZ usually occur within five to nine weeks after beginning therapy.1 In the present case, psoriasis worsening occurred nine weeks after starting therapy, in agreement with the literature. Guttate, inverse, and palmoplantar presentations of psoriasis exacerbations have been described with the use of ATZ.1 Therefore, the case highlights the combination related to the eruption, and also the unusual pustular presentation.

Financial support

None declared.

Authors' contributions

Mariani Magnus Andrade: Collection, analysis and interpretation of data; drafting and editing of the manuscript or critical review of important intellectual content; critical review of the literature.

Guilherme Ladwig Tejada: Collection, analysis and interpretation of data; drafting and editing of the manuscript or critical review of important intellectual content; critical review of the literature.

Juliano Peruzzo: Analysis and interpretation of data; critical review of important intellectual content; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature.

Renan Rangel Bonamigo: Analysis and interpretation of data; critical review of important intellectual content; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature.

Conflicts of interest

None declared.

References
[1]
S.R. Ellis, A.T. Vierra, J.W. Millsop, M.E. Lacouture, M. Kiuru.
Dermatologic toxicities to immune checkpoint inhibitor therapy: a review of histopathologic features.
J Am Acad Dermatol., 83 (2020), pp. 1130-1143
[2]
A. Luengas-Martinez, J. Hardman-Smart, R. Paus, H.S. Young.
Vascular endothelial growth factor-A as a promising therapeutic target for the management of psoriasis.
Exp Dermatol., 29 (2020), pp. 687-698
[3]
S.S. Shord, L.R. Bressler, L.A. Tierney, S. Cuellar, A. George.
Understanding and managing the possible adverse effects associated with bevacizumab.
Am J Health Syst Pharm., 66 (2009), pp. 999-1013
[4]
A. Akman, E. Yilmaz, H. Mutlu, M. Ozdogan.
Complete remission of psoriasis following bevacizumab therapy for colon cancer.
Clin Exp Dermatol., 34 (2009), pp. e202-e204
[5]
A. Datta-Mitra, N.K. Riar, S.P. Raychaudhuri.
Remission of psoriasis and psoriatic arthritis during bevacizumab therapy for renal cell câncer.
Indian J Dermatol., 59 (2014), pp. 632

Study conducted at the Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.

Copyright © 2023. Sociedade Brasileira de Dermatologia
Download PDF
Idiomas
Anais Brasileiros de Dermatologia
Article options
Tools
en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.