Erythema nodosum-like panniculitis mimicking disease recurrence: A novel toxicity from immune checkpoint blockade therapy-Report of 2 patients.

Immunotherapies targeting cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and the programmed cell death 1 (PD-1) receptor and its ligand (PD-L1) have showed substantial therapeutic benefit in patients with clinically advanced solid malignancies. However, autoimmune toxicities are common and often significant adverse events with these agents. While rash and pruritus remain the most common cutaneous complications in treated patients, novel dermatologic toxicities related to immune checkpoint blockade continue to emerge as the number of patients exposed to immunotherapy increases. Here, we describe 2 patients treated with combination immunotherapy with ipilimumab and nivolumab who developed painful subcutaneous nodules. Although the findings were clinically concerning for disease recurrence, histopathologic examination of biopsies from the lesions revealed a subcutaneous mixed septal and lobular erythema nodosum-like panniculitis. Notably, neither patient received immunosuppressive therapy for these lesions, which subsequently remained stable, and both patients' cancer remained controlled. These cases show that the dermatologic toxicity profile of immune checkpoint blockade is diverse and continues to expand, and illustrates that recognition of such toxicities is critical to optimal patient management.

Granuloma Annulare Secondary to Vemurafenib Therapy for Lung Adenocarcinoma.

Numerous cutaneous manifestations have been associated with use of BRAF inhibitors, including two previously reported cases of granuloma annulare (GA) eruptions associated with vemurafenib therapy. Both of these patients were being treated for metastatic melanoma. In this report, we describe the case of a 71-year-old man who developed classic GA lesions while being treated with vemurafenib monotherapy for nonmelanoma cancer, specifically metastatic lung adenocarcinoma positive for BRAF V600 mutation.

J Drugs Dermatol. 2017;16(10):1050-1052.

Nanoparticles: a closer look at their dermal effects.

Nano-sized particles represent a unique class of materials with novel physiochemical properties due to increased surface area. Many sunscreens and cosmetics are now using nano-sized titanium dioxide and zinc oxide, which avoids the white, chalky appearance of the older preparations. Although the U.S. Food and Drug Administration (FDA) has determined that nano-sized titanium dioxide is not a new ingredient, but a specific grade of the original product, recent studies suggest that nanomaterials products may not be equivalent to their respective bulk-form products, and the adverse effects of nanoparticles cannot be reliably predicted from the properties of the material in bulk form. Nanoparticles are incorporated into a variety of skin care products, and in the future may be useful as transdermal drug delivery devices. Thus, understanding potential epidermal and dermal penetration, as well as possible toxicity, is important to the field of dermatology. The authors present a review of the therapeutic applications and potential toxicity of nanoparticles relevant to the field of dermatology thus far.