Dr. Anisha Patel focuses on pearls from her lecture Immunotherapy in Dermatology: Innovations and Clinical Applications at the 2nd Annual Elevate-Derm Alliance Summer Conference at the Grand Hyatt Deer Valley in Park City, Utah.

In this video

Dr. Patel frames immune checkpoint inhibitors as both "friends and foes" of dermatology — they extend life in advanced melanoma and other malignancies, but carry a 20–60% incidence of skin toxicity, rising above 50% with combination or bispecific regimens. The most common patterns mirror the T-cell-mediated inflammatory diseases dermatologists already know: psoriasis, eczema, and lichenoid dermatitis (checkpoint-inhibitor-induced lichen planus), plus rarer but high-impact bullous pemphigoid and, occasionally, Stevens-Johnson syndrome/TEN.

Management, she stresses, requires "more to think about" than a standard rash — the status of the malignancy, whether the patient is on active therapy or will be re-challenged, and what alternatives exist. Because a prednisone taper only holds until the next infusion, she often moves from topicals straight to targeted biologics, skipping the in-between agents whose side-effect profiles are inappropriate for someone on active cancer therapy or could raise metastatic risk. Toxicities can persist a year or more after the last dose, with no reliable predictive factors — but there's a silver lining: at MD Anderson, skin toxicity in melanoma patients has been associated with better tumor response.

  • Skin toxicity affects 20–60% of patients on checkpoint inhibitors, and more than 50% when agents are combined or bispecific — a major space for dermatology to contribute to cancer care.
  • The common presentations are the familiar T-cell-mediated diseases — psoriasis, eczema, lichenoid dermatitis — plus rarer bullous pemphigoid and, occasionally, SJS/TEN.
  • A steroid taper isn't a long-term fix; the rash flares with each infusion, so favor longitudinal, targeted therapies while carefully vetting side-effect profiles so as not to undo the checkpoint inhibitor's benefit or increase metastatic risk.
  • Counsel patients that cutaneous toxicities may persist a year or more after the culprit drug is stopped, and there are currently no good predictors of who will resolve versus persist.
  • With checkpoint inhibitors increasingly combined with targeted and cytotoxic agents, knowing which drug is driving the toxicity lets the dermatologist tell the oncologist which agent to delay or dose-reduce — and skin toxicity may signal better tumor response.