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Imiquimod/nivolumab Severe mucocutaneous toxicity in the form of bullous lichen planus: case report A 77-year-old man exhibited severe mucocutaneous toxicity in the form of bullous lichen planus while receiving combination treatment with imiquimod and nivolumab for cutaneous metastases of melanoma. The man, who had cutaneous metastases of a melanoma of the left heel, started receiving nivolumab [dosage and route not stated]. After 5 months of well-tolerated nivolumab therapy, the lesions were only stabilised. Thus, a local application of imiquimod was initiated at a frequency of 5 days/week [dose, strength or amount of drug application not stated], along with continuing nivolumab therapy. Within one month, the cutaneous metastases started to resolve. However, three weeks after initiation of imiquimod, he started to develop bullous cheilitis, ulcerated stomatitis and lichen-like purple plaques on the limbs. Subsequent skin biopsy results suggested possibility of a bullous lichen planus. Direct and indirect immunofluorescence, and immunoblot analysis ruled out possibility of lichen planus pemphigoides. Therefore, he was diagnosed with bullous lichen planus, which was attributed to the combination therapy of nivolumab and imiquimod. The man’s combination therapy with nivolumab and imiquimod was therefore discontinued, and he was treated with local and general corticosteroids. A subsequent resolution of the bullous lichen planus was observed. Thereafter, the man restarted nivolumab monotherapy, and no recurrence of lichen planus-like lesions was reported. Author comment: Here we report a case of severe mucocutaneous toxicity [in the form of bullous lichen planus] attributable to the combination of nivolumab with imiquimod. Costedoat I, et al. Imiquimod-induced bullous lichen planus in a patient treated with nivolumab. Annales de Dermatologie et de Venereologie 146 (Suppl. 12): A325 (plus poster) abstr. P378, Dec 2019. Available from: URL: http:// doi.org/10.1016/j.annder.2019.09.544 [French abstract; summarised from a 803439527 translation] - France

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Reactions 14 Dec 2019 No. 1783