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A Standardized Procedure of Dressing Management for Toxic Epidermal Necrolysis

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Cutaneous Immune-Related Adverse Events Secondary to Immune Checkpoint Inhibitors and Their Management.

J Pach¹, J S Leventhal²

¹Yale University School of Medicine, New Haven, CT, USA.

Critical Reviews in Immunology

|April 6, 2023

Summary

Immune checkpoint inhibitors (CPIs) effectively treat cancer but can cause skin issues. Recognizing and managing these immune-related adverse events (irAE) is crucial for continued cancer therapy.

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Area of Science:

Oncology
Dermatology
Immunology

Background:

Immune checkpoint inhibitors (CPIs) are vital cancer therapies that enhance antitumor immunity by modulating T-cell activity.
Overactivation of T cells due to CPIs can lead to immune-related adverse events (irAE), with cutaneous manifestations being the most frequent.
These skin reactions range from common pruritus and maculopapular eruptions to rare, severe conditions like Stevens-Johnson Syndrome.

Approach:

This review synthesizes current knowledge on the presentation and management of dermatologic irAE associated with CPI therapy.
It categorizes these events based on frequency and severity, including common, less common, and severe reactions.
The review also addresses the exacerbation of pre-existing autoimmune skin diseases.

Key Points:

Common cutaneous irAE include maculopapular eruption, pruritus, lichenoid dermatitis, and vitiligo.
Less common irAE encompass psoriasis, bullous pemphigoid, and alopecia areata.
Severe irAE such as AGEP, DRESS, and SJS/TEN require urgent attention, alongside management of exacerbated autoimmune dermatoses.

Conclusions:

Effective recognition and management of cutaneous irAE are essential to optimize CPI therapy and prevent treatment discontinuation.
Understanding the spectrum of dermatologic side effects allows for timely intervention and improved patient outcomes.
This review provides a comprehensive guide for clinicians managing CPI-induced skin toxicities.