TABLE II.

Management recommendations for dermatologic toxicity from immune checkpoint inhibitor therapy (ICIT)

Toxicity grade	Definition
1	Symptoms not affecting quality of life, or lesions covering less than 10% of body surface area, without erythema
	ASCO and ESMO recommendations
	Topical emollients Mild-to-moderate topical corticosteroid daily Continue ICIT
2	Symptoms affecting quality of life, including lesions covering 10%–30% of body surface area, without meeting criteria for grade 3 or 4 toxicity
	ASCO recommendations	ESMO recommendations
	Topical antihistamine therapy Medium- to high-potency topical steroid therapy Systemic corticosteroid therapy could be considered (prednisone equivalent 1 mg/kg daily) Consider holding ICIT until symptoms improve to grade 1	Twice-daily topical steroid use (moderate-to-potent strength) Oral or topical antihistamine therapy Continue ICIT Consider dermatology referral
3	Symptoms present as skin sloughing, or lesions involving more than 30% of body surface area, with associated pain and effect on activities of daily living or failure to respond to therapy for grade 2 toxicity
	ASCO recommendations	ESMO recommendations
	Hold ICIT Consult dermatology Topical emollients Oral antihistamine therapy High-potency topical steroid therapy Methylprednisolone 1–2 mg/kg (or equivalent), tapering over 4 or more weeks Consider rituximab for bullous pemphigoid Restart ICIT after consultation with dermatologist	Hold ICIT Potent topical steroid therapy For mild symptoms, use oral corticosteroid (for example, prednisone or equivalent 0.5–1 mg/kg), and wean over 1–2 weeks For severe symptoms, use intravenous methylprednisolone 0.5–1 mg/kg (or equivalent), and wean over 2–4 weeks Restart ICIT after discussion with dermatologist and symptoms improved to grade 1 or mild grade 2
4	Symptoms present as intolerable or severe rashes unmanageable with grades 1–3 interventions, or blistering involving more than 30% of body surface area, with associated fluid or electrolyte abnormalities
	ASCO recommendations	ESMO recommendations
	Discontinue ICIT Admit patient to hospital with urgent dermatology consultation Intravenous methylprednisolone 1–2 mg/kg (or equivalent) Consider infectious disease consultation if secondary cellulitis is suspected, or other infectious risk factors are present	Discontinue ICIT Urgent dermatology assessment with biopsy Intravenous methylprednisolone 1–2 mg/kg (or equivalent)