阿帕吡胺是用于治疗前列腺癌的抗雄激素药物。尽管它有时会引发轻度的皮肤不良反应，偶尔也会出现严重的反应，但严重和轻度情况之间的临床差异尚不清楚。为了评估经历阿帕吡胺相关皮肤不良反应（ARCAEs）的患者的风险，我们旨在描述严重和轻度ARCAEs的发生时间和淋巴细胞转化试验（LTT）结果。我们回顾了41例ARCAE病例：其中24例来自我们的机构，17例来自文献报道，包括（i）8例严重病例，其中包括6例毒性表皮坏死，1例急性全身性脓疱病，1例伴有嗜酸性粒细胞增多和全身症状的药物反应，以及（ii）33例轻度病例。严重病例的ARCAEs的发生时间明显早于轻度病例（5.2周对9.6周）。没有在开始阿帕吡胺治疗后≥8周出现严重病例。LTT结果显示7例轻度病例中2例阳性（28.6%），4例严重病例中4例阳性（100.0%）。总之，我们发现严重ARCAEs的特征是较早的发病时间和LTT阳性。皮肤科医生和泌尿科医生应特别关注在开始阿帕吡胺治疗后<8周出现ARCAEs和/或LTT呈阳性的患者。©2023年日本皮肤科学会。

Apalutamide is an antiandrogen used to treat prostate cancer. Although it sometimes induces mild cutaneous adverse events and occasionally severe ones, clinical differences between severe and mild cases remain unclear. To assess the risks in patients experiencing apalutamide-related cutaneous adverse events (ARCAEs), we aimed to characterize severe and mild ARCAEs in terms of onset time and lymphocyte transformation test (LTT) for apalutamide. We reviewed 41 ARCAE cases: 24 from our institute and 17 from the literature, comprising (i) eight severe cases including six with toxic epidermal necrolysis, one with acute generalized exanthematous pustulosis, and one with drug reaction with eosinophilia and systemic symptoms, and (ii) 33 mild cases. Patients with evere cases developed ARCAEs significantly earlier than patients with mild cases (5.2 vs 9.6 weeks). No severe cases appeared ≥8 weeks after initiation of apalutamide. LTTs showed positive results in two of seven mild cases (28.6%) and four of four severe cases (100.0%). In conclusion, we found that severe ARCAEs are characterized by earlier onset and LTT positivity. Dermatologists and urologists should pay special attention to patients who develop ARCAEs <8 weeks after initiating apalutamide and/or show positive LTT results.© 2023 Japanese Dermatological Association.