Immune checkpoint inhibitors (ICIs) are associated with dermatologic adverse effects. We present two patients who developed inflammatory vulvar dermatoses after ICI therapy. The first patient, an 81-year-old with rectosigmoid adenocarcinoma, was treated initially with chemotherapy and radiation followed by pembrolizumab for local tumor regrowth. After her second dose, she experienced vulvar pruritus with skin sloughing. Exam demonstrated hyperkeratotic white plaques on bilateral labia majora (Figure 1A). Biopsies confirmed psoriasiform epidermal hyperplasia with squamous atypia and perivascular lymphocytic inflammation. Pembrolizumab was held and she started clobetasol cream. After 2 months, her symptoms improved. Post-treatment exam showed residual skin thickening with resolution of skin sloughing suggestive of ICI-related radiation recall. The second patient, a 68-year-old, received ipilimumab and nivolumab for urethral mucosal melanoma. Shortly after therapy initiation, she developed vulvar pruritus. Pelvic exam demonstrated thickened, edematous, hypopigmented labial skin (Figure 1B). She started clobetasol cream and symptoms resolved completely after 2 weeks.
Figure 1:
Hyperkeratotic plaques on bilateral labia majora extending bilaterally to the gluteal clefts after starting pembrolizumab (A). Thickened, edematous, hypopigmented skin on bilateral labia and vulva during treatment with ipilimumab and nivolumab (B).
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Footnotes
Conflicts of Interest: The authors report no conflict of interest.
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