Table 1.
Cutaneous side effects observed during targeted therapy (BRAF and MEK inhibitors) and immunotherapy (CTLA-4 and PD-1 inhibitors) and their management.
| Target | Skin toxicity | Management |
|---|---|---|
| Skin rash (maculopapular) | Topical steroids (clobetasol propionate); oral corticosteroids (prednisone); oral antihistamines; emollient agents | |
| BRAF inhibitors (i) Vemurafenib (ii) Dabrafenib | ||
| Photosensitivity | Avoid sun (broad-spectrum sunscreens that cover UVA spectrum, protective clothing) | |
| Palmarplantar hyperkeratosis | Urea cream; avoid friction | |
| Verrucal keratosis | Cryotherapy; monitor for changes suggestive of SCC; acitrein as a chemopreventive drug | |
| Squamous cell carcinoma, alopecia, and hair modifications | Excision, minoxidil 2% | |
| Panniculitis | Nonsteroidal anti-inflammatory drugs; oral steroids (prednisolone) | |
| Melanocytic proliferation | Dermoscopic monitoring; radical surgery for melanomas; education on photoprotection and self-skin examination | |
| BCC | Excision | |
|
| ||
| MEK inhibitors | Acneiform rash (papulo-pustular) | Topical antibiotics (clindamycin, erythromycin); oral antibiotics (doxycycline, monocycline); topical steroids (prednicarbate); oral steroids (prednisone); oral antihistamines; oral isotretinoin |
| (i) Trametinib | ||
| (ii) Cobimetinib | ||
|
| ||
| CTLA-4 inhibitors | Rash (maculopapular, lichenoid eruption), eczema | Medium-to-high potency topical (and sometimes oral) corticosteroids; antihistamines |
| (i) Ipilimumab | ||
|
| ||
| PD-1 inhibitors | Vitiligo, psoriasis, autoimmune blistering disorders | |
| (i) Nivolumab | ||
| (ii) Pembrolizumab | ||