Navigating skin toxicity in the era of immunotherapy

Immunotherapy continues to revolutionize cancer treatment, instilling optimism and enhancing prognoses across diverse malignancies. Immune checkpoint inhibitors (ICIs), including cytotoxic T lymphocyte–associated-protein 4 (CTLA-4), programmed death receptor 1 (PD-1), programmed death ligand 1 (PD-L1), and lymphocyte activation gene 3 (LAG-3) represent a paradigm shift. However, these transformative therapies introduce immune-related adverse events (irAEs), distinct from conventional cancer treatments, with delayed onset and potential persistence. While most cutaneous irAEs are mild, severe toxicity can occur, underscoring the importance of early detection and effective management. Cutaneous toxicities linked to ICIs manifest as various skin eruptions, affecting up to 71.5% of cases. The presentation is varied, including maculopapular rash, pruritus, psoriasiform, eczematous, and lichenoid dermatoses, with severe cases like Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms (DRESS). Recognizing and managing ICI cutaneous toxicity is crucial for optimizing these life-saving cancer treatments.