Fwd: Diagnostic and Therapeutic Differences Between Immune Checkpoint Inhibitor–Induced and Idiopathic Bullous Pemphigoid

Journal Scan / Research · June 27, 2020

Diagnostic and Therapeutic Differences Between Immune Checkpoint Inhibitor–Induced and Idiopathic Bullous Pemphigoid

The British Journal of Dermatology

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• Compared with patients with idiopathic bullous pemphigoid (iBP), those with immune checkpoint inhibitor–induced BP (ICI-BP) had a longer period of rash-free pruritus (median 28 vs 7 days; P < .001), had a longer delay from symptom onset to diagnosis (median 210 vs 91.5 days; P = .04), and were more likely to require systemic immunosuppression to induce remission (OR, 9.4; P = .04). Of the 15 patients with ICI-BP included in this study, none achieved remission on tetracycline and niacinamide therapy. Most required either a delay in their ICI dose (33%) or permanent discontinuation of ICI (53%) due to BP. Patients with ICI-BP also had higher rates of peripheral eosinophilia than those with iBP (OR, 13.1; P = .005).

• The authors recommend that all patients with intractable ICI–induced pruritus undergo workup for ICI-BP, including biopsy for DIF, BP autoantibody testing, and CBC to assess for peripheral eosinophilia.

– Caitlyn T. Reed, MD

Abstract

Bullous pemphigoid (BP) is a serious, rare complication from immune checkpoint inhibitors (ICIs). While most dermatologic immune-related adverse events (irAEs) present early and are mild, ICI-induced BP (ICI-BP) manifests months into therapy and can prompt ICI discontinuation and severe immunosuppression. Following irAE management guidelines, providers rely on systemic corticosteroids - which, at high doses, may confer poorer oncologic outcomes for ICI patients. Our study aims to identify diagnostic and therapeutic differences between ICI-BP and idiopathic BP (iBP) to assist providers in prompt recognition and management of this skin toxicity.

The British Journal of Dermatology

Diagnostic and Therapeutic Differences Between Immune Checkpoint Inhibitor-Induced and Idiopathic Bullous Pemphigoid: A Cross-Sectional Study

Br J Dermatol 2020 Jun 12;[EPub Ahead of Print], GE Molina, KL Reynolds, ST Chen 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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