Skin toxicity – Grade 2-4 – Medium risk

Assessment and investigations

  • Biopsy should be done

Management escalation pathway

  • Treat ambulatory or hospitalize
  • Apply topical steroids as indicated
  • Apply symptomatic treatment to associated symptoms (e.g. itching, dry skin) as indicated second-generation antihistamines
  • Initiate oral/iv methylprednisolone at a dose of 1mg/kg BW per day in case of steroid responsive toxicity
  • Treat with antibiotics as indicated after taking swaps

Symptoms resolved to grade 0 or 1


  • restart ICPI (can be combined with topical corticoids but not with oral corticoids)
  • Taper oral steroids over >1 month
  • For bullous dermatitis, a long corticosteroid taper is indicated followed by a period of low dose corticosteroids (3-4 months with 4-8 mg/d)


  • Hospitalize patient
  • Consider increasing the dose of steroids to 2 mg/kg BW
  • For bullous dermatitis resistant to corticoids Omalizumab (anti-IgE) might be considered (experience and not evidence based)


BSA: Body Surface Area
ADL: Activities of Daily Living
BW: Body Weight
ICU: Intensive Care Unit