Immune checkpoint inhibitor–related dermatologic adverse events Miscellaneous
| Authors: | Geisler, A. N.; Phillips, G. S.; Barrios, D. M.; Wu, J.; Leung, D. Y. M.; Moy, A. P.; Kern, J. A.; Lacouture, M. E. |
| Title: | Immune checkpoint inhibitor–related dermatologic adverse events |
| Abstract: | Immune checkpoint inhibitors have emerged as a pillar in the management of advanced malignancies. However, nonspecific immune activation may lead to immune-related adverse events, wherein the skin and its appendages are the most frequent targets. Cutaneous immune-related adverse events include a diverse group of inflammatory reactions, with maculopapular rash, pruritus, psoriasiform and lichenoid eruptions being the most prevalent subtypes. Cutaneous immune-related adverse events occur early, with maculopapular rash presenting within the first 6 weeks after the initial immune checkpoint inhibitor dose. Management involves the use of topical corticosteroids for mild to moderate (grades 1-2) rash, addition of systemic corticosteroids for severe (grade 3) rash, and discontinuation of immunotherapy with grade 4 rash. Bullous pemphigoid eruptions, vitiligo-like skin hypopigmentation/depigmentation, and psoriasiform rash are more often attributed to programmed cell death-1/programmed cell death ligand-1 inhibitors. The treatment of bullous pemphigoid eruptions is similar to the treatment of maculopapular rash and lichenoid eruptions, with the addition of rituximab in grade 3-4 rash. Skin hypopigmentation/depigmentation does not require specific dermatologic treatment aside from photoprotective measures. In addition to topical corticosteroids, psoriasiform rash may be managed with vitamin D3 analogues, narrowband ultraviolet B light phototherapy, retinoids, or immunomodulatory biologic agents. Stevens–Johnson syndrome and other severe cutaneous immune-related adverse events, although rare, have also been associated with checkpoint blockade and require inpatient care as well as urgent dermatology consultation. © 2020 American Academy of Dermatology, Inc. |
| Keywords: | pruritus; maculopapular rash; lichenoid eruption; vitiligo; dermatologic adverse event; checkpoint inhibitor; pd-1 inhibitor; pd-l1 inhibitor; ctla-4 inhibitor; immune-related cutaneous adverse event |
| Journal Title: | Journal of the American Academy of Dermatology |
| Volume: | 83 |
| Issue: | 5 |
| ISSN: | 0190-9622 |
| Publisher: | Mosby Elsevier |
| Date Published: | 2020-11-01 |
| Start Page: | 1255 |
| End Page: | 1268 |
| Language: | English |
| DOI: | 10.1016/j.jaad.2020.03.132 |
| PUBMED: | 32454097 |
| PROVIDER: | scopus |
| PMCID: | PMC7572894 |
| DOI/URL: | |
| Notes: | Review -- Export Date: 2 November 2020 -- Source: Scopus |
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