Immune-Related Dermatologic Reactions in Cancer Patients Undergoing Immunotherapy: A Case Series

Abstract

Immune checkpoint inhibitors (ICIs) have transformed the treatment paradigm across various malignancies by reactivating T cell responses against tumor cells. These agents function by blocking inhibitory checkpoint pathways, thereby preventing immune downregulation and enhancing antitumor immunity. Despite their clinical success and relatively favorable safety profile, ICIs are associated with immune-related adverse events (irAEs), which can impact multiple organ systems. Among these, cutaneous irAEs are some of the most common, owing to the skin's immunologic sensitivity. These manifestations range from mild conditions—such as pruritus, maculopapular rashes, and inflammatory dermatoses including eczema, psoriasis, and lichenoid reactions—to more severe immunobullous disorders (such as bullous pemphigoid, pemphigus vulgaris, and Stevens–Johnson syndrome). While most cutaneous irAEs can be effectively managed without interrupting immunotherapy, certain cases may require prompt, multidisciplinary intervention to prevent serious complications. This case series presents four diverse malignancies complicated by dermatologic irAEs, highlighting atypical presentations, critical warning signs, and evidence-based strategies for management. Through these cases, we aim to raise awareness about less common cutaneous toxicities and offer practical guidance to ensure safe continuation of cancer immunotherapy.

Keywords

dermatology - immune checkpoint inhibitors - immune-related adverse events

Authors' Contributions

Conceptualization was performed by R.C., C.D., S.R., A.V., V.K., and M.A.O.. Data curation was performed by R.C., M.A.O., and V.K. Project administration was managed by C.D., S.R., and A.V. Original draft preparation was undertaken by R.C., C.D., S.R., A.V., V.K., and M.A.O. All authors—R.C., C.D., S.R., A.V., V.K., and M.A.O.—contributed to the review and editing of the manuscript and provided final approval of the version to be submitted. The corresponding author is the guarantor of the submission.

Ethical Approval

For this case series, formal consent from a local ethics committee is not required.

Patients' Consent

The authors certify that they have obtained the appropriate consent from the patients. The patients have given their consent for the images and other clinical information to be reported in the journal. The patients understand that the name and initials will not be published, and due efforts have been made to conceal the same.

Publikationsverlauf

Artikel online veröffentlicht:
08. September 2025

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