A review of bullous pemphigoid associated with PD‐1 and PD‐L1 inhibitors

Abstract

Prodromal or "non-bullous" variants of BP must be considered in patients treated with checkpoint inhibitors who develop protracted or worsening pruritus. Early diagnostic immunological evaluation of the skin may lead to improved patient outcomes by facilitating timely initiation of treatment and prevent disruptions in cancer therapy.

Cases from the irAE Tumor Board: A Multidisciplinary Approach to a Patient Treated with Immune Checkpoint Blockade Who Presented with a New Rash

“…Other labs may be performed based on the clinical presentation: hepatic and renal function tests for patients with systemic involvement such as DRESS; antinuclear, anti‐Ro, anti‐La, ds‐DNA antibodies for those with suspected autoimmune conditions such as lupus or dermatomyositis. Serum enzyme‐linked immune sorbent assay (ELISA) for the pathognomonic antibodies to BP180 and BP230 can be performed to confirm the diagnosis of bullous pemphigoid . A skin biopsy can be useful in patients in whom an alternate diagnosis is being considered, for rashes that are resistant to initial treatment and for patients with suspected SCARs.…”

A case of atezolizumab‐induced photodistributed bullous pemphigoid

“…F I G U R E 2 Hematoxylin and eosin staining revealed a pauci-inflammatory subepidermal bullae F I G U R E 3 Direct immunofluorescence showed 1+ homogenous staining of the basement membrane with antisera to IgG and C3 Immunotherapy-associated BP portends significant management implications. Unlike the majority of immunotherapy rashes that are typically treated with topical steroids while continuing the checkpoint inhibitor, BP is most commonly treated with systemic steroids along with at least temporary cessation of the immunotherapy agent and steroid-sparing medications if indicated (Lopez, Khanna, Antonov, Audrey-Bayan, & Geskin, 2018). In the largest cohort to date of seven patients with immunotherapyinduced BP, all patients were treated with systemic corticosteroids and immunotherapy was discontinued at least temporarily (Siegel et al, 2018).…”

Severe bullous pemphigoid in a metastatic lung cancer patient treated with pembrolizumab

“…Bullous pemphigoid (BP) has been proposed as one of the cutaneous irAE. 2 In most cases, the severity of BP is mild, and their clinical features are basically similar to those of common BP. 2,3 Here, we report a case of severe BP with characteristic clinical features in a patient treated with pembrolizumab.…”