{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:28:06Z","timestamp":1785767286787,"version":"3.56.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,10,22]],"date-time":"2024-10-22T00:00:00Z","timestamp":1729555200000},"content-version":"vor","delay-in-days":717,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Targeted therapy with BRAF- and MEK-Inhibitors (BRAFi, MEKi) provides an excellent therapeutic option for patients with malignant melanomas with a BRAF-Mutation. Mild cutaneous adverse events have been common under the BRAF- and MEK-Inhibitor therapy, on the contrary, severe cutaneous adverse reactions to drugs (SCARs) are rarely reported. We present the case of a 59- year-old female patient who after the resection of cutaneous in-transit metastases of a malignant melanoma received one adjuvant cycle of Nivolumab followed by a switch of the therapy to an oral BRAFi\/MEKi therapy. 3\u20134 Weeks after the therapy switch she developed high fever, chills, progredient general weakness, headaches, abdominal complaints, generalised rash as well as thrombocytopaenia, eosinophilia, elevated liver enzymes, declining kidney, and pulmonary function as well as a maculopapular exanthema. She was diagnosed with drug reaction with eosinophilia and systemic symptoms (DRESS) and quickly started recovery after initiation of a high steroid substitution. Under steroid dose reduction, the exanthema worsened and toxic epidermal necrolysis (TEN) was histologically diagnosed. After a series of unsuccessful therapeutic approaches (high dose steroid, human immunoglobulins and ciclosporin) the patient received a single dose of the TNF-alpha inhibitor etanercept, which led to a quick recovery. This case demonstrates that DRESS and TEN can present a spectrum of possibly transitioning SCARs providing a diagnostic and therapeutic challenge. Nevertheless, in a such complicated therapeutic setting, etanercept may be lifesaving even after multiple previous unsuccessful therapies. This effective approach provides evidence SCARs due to BRAF\/MEK targeted therapy may be driven by TNF-alpha.<\/jats:p>","DOI":"10.1002\/ski2.185","type":"journal-article","created":{"date-parts":[[2022,11,5]],"date-time":"2022-11-05T12:31:40Z","timestamp":1667651500000},"source":"Crossref","is-referenced-by-count":9,"title":["Etanercept Leads to a Rapid Recovery of a Dabrafenib-\/Trametinib-Associated Toxic Epidermal Necrolysis-Like Severe Skin Reaction"],"prefix":"10.1093","volume":"3","author":[{"given":"Krista","family":"Yordanova","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venereology and Allergology, Saarland University Medical Center , Homburg\/Saar ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Pf\u00f6hler","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Allergology, Saarland University Medical Center , Homburg\/Saar ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca F.","family":"Schweitzer","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Allergology, Saarland University Medical Center , Homburg\/Saar ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Bourg","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Allergology, Saarland University Medical Center , Homburg\/Saar ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonie","family":"Adam","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Allergology, Saarland University Medical Center , Homburg\/Saar ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Vogt","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Allergology, Saarland University Medical Center , Homburg\/Saar ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,11,5]]},"reference":[{"issue":"5","key":"2025010818130184500_ski2185-bib-0001","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1007\/s00262-019-02311-1","article-title":"First-line therapy-stratified survival in BRAF-mutant melanoma: a retrospective multicenter analysis","volume":"68","author":"Schilling","year":"2019","journal-title":"Cancer Immunol Immunother"},{"issue":"19","key":"2025010818130184500_ski2185-bib-0002","doi-asserted-by":"publisher","first-page":"1813","DOI":"10.1056\/nejmoa1708539","article-title":"Adjuvant dabrafenib plus trametinib in stage III BRAF-mutated melanoma","volume":"377","author":"Long","year":"2017","journal-title":"N Engl J Med"},{"issue":"3","key":"2025010818130184500_ski2185-bib-0003","doi-asserted-by":"publisher","DOI":"10.1136\/esmoopen-2019-000491","article-title":"Tolerability of BRAF\/MEK inhibitor combinations: adverse event evaluation and management","volume":"4","author":"Heinzerling","year":"2019","journal-title":"ESMO Open"},{"issue":"8","key":"2025010818130184500_ski2185-bib-0004","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1007\/s40264-019-00825-2","article-title":"Mechanisms of severe cutaneous adverse reactions: recent advances","volume":"42","author":"Bell\u00f3n","year":"2019","journal-title":"Drug Saf"},{"key":"2025010818130184500_ski2185-bib-0005","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/1503709","article-title":"Treatments for severe cutaneous adverse reactions","volume":"2017","author":"Cho","year":"2017","journal-title":"J Immunol Res"},{"issue":"6","key":"2025010818130184500_ski2185-bib-0006","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1111\/ddg.14118_g","article-title":"Erythema exsudativum multiforme, Stevens-Johnson-Syndrom\/toxische epidermale Nekrolyse \u2013 Diagnostik und Therapie","volume":"18","author":"Gr\u00fcnwald","year":"2020","journal-title":"JDDG J der Deutschen Dermatol Gesellschaft"},{"issue":"1","key":"2025010818130184500_ski2185-bib-0007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40425-018-0475-y","article-title":"Cutaneous adverse reactions in B-RAF positive metastatic melanoma following sequential treatment with B-RAF\/MEK inhibitors and immune checkpoint blockade or vice versa. 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