Table 1.
Types of dermatologic toxicities reported with anti-CTLA-4, anti-PD-1 and PDL-1 antibody therapy [18]
| Category | Dermatologic toxicity | Clinical presentation | Histologic feature | Anti-CTLA-4 | Anti-PD-1 | Anti-PDL-1 |
|---|---|---|---|---|---|---|
| Inflammatory | Acneiform | Not reported | Not reported | Yes | Yes | Yes |
| AGEP (acute generalized exanthematous pustulosis) | Oedematous, erythematous pustules | Subcorneal neutrophils with eosinophils | Yes | Yes | Yes | |
| CD30 lymphomatoid reaction | 3 to 6-mm pink papules coalescing into plaques on the abdomen and back | CD30+ lymphoid infiltrate with overlying epidermal hyperplasia | Yes | No | No | |
| Dermatomyositis | Photo-distributed, erythematous eruption on the face and upper chest, erythematous papules over the dorsal hand, nail fold and eyelid erythema, muscle weakness | Not performed | Yes | No | No | |
| DHR (dermal hypersensitivity reaction) | Maculopapular eruption on the trunk and extremities | Perivascular lymphocytic inflammation with ± eosinophils and spongiosis | Yes | Yes | Yes | |
| DRESS (drug reaction with eosinophilia and systemic symptoms) | Diffuse maculopapular rash with erythroderma | Not performed | Yes | No | No | |
| Eczema/spongiotic | No | Yes | Yes | |||
| Erythema/erythematous | No | Yes | Yes | |||
| Exfoliative | No | Yes | Yes | |||
| Lichenoid/interface | Not reported | Not reported | Yes | Yes | Yes | |
| Maculopapular | No | Yes | Yes | |||
| Pityriasis lichenoides (PL)-like skin lesions | No | Yes | Yes | |||
| Photosensitivity | Erythematous macules on sun-exposed sites with subsequent plaques on the scalp, trunk and extremities | Spongiotic dermatitis with eosinophils and parakeratosis and acanthosis | Yes | Yes | Yes | |
| Psoriasiform | No | Yes | Yes | |||
| Pyoderma gangrenosum | Ulcerated, erythematous nodule | Ulcer with neutrophilic dermal inflammation | Yes | No | No | |
| Radiation-associated dermatitis | Blisters within the radiated area | Not performed | Yes | Yes | Yes | |
| Sweet syndrome | Erythematous, tender papules and plaques on the face, trunk and extremities | Papillary dermal oedema and neutrophilic inflammation | Yes | No | No | |
| SJS/TEN (Stevens–Johnson syndrome/ toxic epidermal necrolysis) | Not specified | Skin necrosis and vasculitis | Yes | Yes | Yes | |
| Vasculopathic | No | Yes | Yes | |||
| Immunobullous | Bullous pemphigoid | No | Yes | Yes | ||
| Dermatitis herpetiformis | Pink papules, grouped near the elbows, back and buttocks | Collection of neutrophils in the papillary dermis, IgA deposits in the dermal papillae | Yes | No | No | |
| Alteration of keratinocytes | Actinic keratosis | No | Yes | Yes | ||
| Basal cell carcinoma | No | Yes | Yes | |||
| Grover’s disease | Papulokeratotic eruption on the trunk | Acantholytic dyskeratosis | Yes | Yes | Yes | |
| Prurigo nodularis | Not reported | Not performed | Yes | No | No | |
| Seborrheic keratosis | No | Yes | Yes | |||
| Squamous cell carcinoma | No | Yes | Yes | |||
| Alteration of melanocytes | Regression of melanocytic naevi | Unremarkable clinically, DELM, alteration in pigment with areas of hyperpigmentation | Lichenoid lymphocytic inflammation of CD8+ lymphocytes associated with naevus cells | Yes | Yes | Yes |
| Tumoral melanosis | Multiple purple, black papules and nodules coalescing into plaques | Nodular aggregates of pigmented macrophages in dermis, absence of viable melanoma cells | Yes | No | No | |
| Vitiligo | Hypopigmentation | Dead melanocytes along dermal-epidermal junction with associated dermal lymphocytic inflammation | Yes | Yes | Yes |