Skin toxicity

General information regarding skin toxicty

Skin toxicity is among one of the most common AEs observed with ICPi and usually develops within the first few weeks aŒfter treatment initiation. However, serious skin toxicity is rare and usually does not require dose reductions, or treatment discontinuation. The most frequent skin AEs are rash, pruritus and vitiligo (typically in melanoma patients). More rarely, other skin AEs have been reported with checkpoint inhibitors: alopecia areata, stomatitis, pemphigus vulgaris, psoriasis and lichenoid skin reactions.

Symptom Grade 1

  • < 10% Body Surface Area
  • Mild
  • Localized
  • Pruritus grade 1

Assessment and investigations

  • Perform anamnesis, clinical assessment, and basic lab tests

Management Escalation Pathway

  • Apply local therapy (topical ultra-high and high potency corticosteroids)
  • Prescribe second-generation antihistamines
  • Continue ICPI and monitor

Resolved to grade 0 or remain grade 1 with good tolerance Worsened to grade > 2: see management guidelines for grade >2 

Click here


Symptom Grade 2

  • > 10% Body Surface Area
  • profound skin infiltration
  • bullous lesions

Click here for more detailed management guideline for grade 2 – 4  skin toxicity




AE: Adverse Event
ICPi: Immune Checkpoint Blockade Inhibition
BSA: Body Surface Area