Assessing Treatment Efficacy for Dermatologic Immune-Related Adverse Events: A Systematic Review

Abstract

The management of dermatologic immune–related adverse events (D-irAEs) remains inconsistent owing to variability in treatment responses and a lack of standardized guidelines. Establishing evidence-based recommendations is critical to improving patient outcomes and minimizing interruptions in immune checkpoint inhibitor therapy. This review aims to systematically evaluate the level of evidence for reported D-irAE treatments and provide insights to guide clinical decision making. Of the D-irAEs identified, those that were commonly reported include maculopapular, lichenoid, psoriasiform, immunobullous (including bullous pemphigoid), granulomatous, vitiligo, and potentially life-threatening erosive mucocutaneous conditions (such as erythema multiforme, Steven–Johnson syndrome, and toxic epidermal necrosis). Treatments ranged from corticosteroids (topical, oral, intravenous) to biologics (eg, omalizumab, rituximab) and oral immunomodulators (eg, methotrexate, apremilast), with topical and oral corticosteroids, along with apremilast, receiving the strongest evidence rating (3B). Although the strongest evidence supports corticosteroids, most treatments for D-irAEs lack robust validation owing to limitations in study type (ie, randomized control trials and prospective cohort studies). This underscores the importance of multidisciplinary approaches to optimize D-irAE management and support continuity in cancer care. Future research should prioritize randomized control trials and prospective cohort studies to aid in standardizing D-irAE treatment protocols to solidify treatment consensus.