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Dermatologic immune-related adverse events: The toxicity spectrum and recommendations for management
Zoe Apalla1, Bernardo Rapoport2,3, Vincent Sibaud4
1Second Dermatology Department, School of Health Sciences, Aristotle University of Thessaloniki, Greece.
Abstract:
Immune checkpoint inhibitors are a new class of oncologic drugs that act via the inhibition of checkpoints, thereby unlocking the immune system to attack cancer cells. Their emergence has radically changed the concept of therapy in oncologic patients. However, despite their overall favorable profile, their use has been associated with specific toxicities that may potentially affect treatment. The so-called immune-related adverse events (irAEs) mostly correspond to dysimmune reactions that can affect nearly every organ system, in theory, notably with the development of colitis, hepatitis, pneumonitis, or thyroiditis. Dermatologic irAEs are also among the most common, reaching a rate of approximately 40%. They are characterized by a wide phenotypic range, including mainly eczematous or lichenoid rashes, psoriasis, or autoimmune bullous disorders. Pruritus may accompany the aforementioned rashes or develop as an isolated symptom without the presence of skin changes. Depigmentation and hair/nail changes can be also observed in association with immune checkpoint inhibitor treatment. In the current article, we present an overview of the clinical spectrum of irAEs and provide tips for early recognition and management of dermatologic irAEs. We highlight the role that dermatologists can play in relieving patients and allowing for oncologic treatment to be maintained and administered more safely.
Insights
Immune checkpoint inhibitors (ICIs) can cause immune-related adverse events (irAEs), particularly skin reactions in about 40% of patients. Early recognition and management by dermatologists are key to safe cancer treatment.
Area of Science:
- Oncology
- Immunology
- Dermatology
Background:
- Immune checkpoint inhibitors (ICIs) represent a significant advancement in cancer therapy by harnessing the immune system against tumors.
- While effective, ICIs can induce immune-related adverse events (irAEs), which are dysimmune reactions affecting various organ systems.
- Dermatologic irAEs are frequent, occurring in up to 40% of patients, and present with diverse clinical manifestations.
Purpose of the Study:
- To provide a comprehensive overview of the clinical spectrum of immune-related adverse events (irAEs) associated with immune checkpoint inhibitors.
- To offer practical guidance for the early recognition and effective management of dermatologic irAEs.
- To emphasize the crucial role of dermatologists in optimizing patient care and enabling the safe continuation of oncologic therapy.
Main Methods:
- Review of the literature on immune checkpoint inhibitors and their associated adverse events.
- Analysis of the clinical presentation and incidence of dermatologic immune-related adverse events.
- Synthesis of current recommendations for the diagnosis and management of skin toxicities.
Main Results:
- Immune-related adverse events (irAEs) manifest across multiple organ systems, including common dermatologic reactions such as rashes, pruritus, and nail/hair changes.
- Dermatologic irAEs exhibit a wide range of phenotypes, including eczematous, lichenoid, psoriatic, and bullous disorders.
- Pruritus can occur independently or alongside other skin manifestations.
Conclusions:
- Dermatologic immune-related adverse events are common complications of immune checkpoint inhibitor therapy.
- Prompt identification and appropriate management of skin toxicities are essential for patient well-being.
- Dermatologists play a vital role in supporting oncologic treatment by effectively managing irAEs, thereby improving patient outcomes and treatment adherence.
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