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Systemic corticosteroids: IV (methyl)prednisolone (or equivalent) dosed at 1–2 mg/kg with slow tapering when the toxicity resolves Monitor closely for progression to severe cutaneous adverse reaction Should admit patient immediately with direct oncology involvement and with an urgent consult by dermatologyĬonsider alternative antineoplastic therapy over resuming ICPis if the skin irAE does not resolve to G1 or less if ICPIs are the patient's only option, consider restarting once these adverse effects have resolved to a G1 levelĭefinition: Including bullous pemphigoid or other autoimmune bullous dermatoses, bullous drug reaction Immediately hold ICPi and consult dermatology to determine appropriateness of resuming ICPi therapy upon resolution of skin toxicity and once corticosteroids are reduced to prednisone (or equivalent) ≤ 10 mg G4: All severe rashes unmanageable with prior interventions and intolerable Initiate (methyl)prednisolone (or equivalent) 1–2 mg/kg, tapering over at least 4 weeks Treat with topical emollients, oral antihistamines, and high-potency topical corticosteroids

Hold ICPi therapy and consult with dermatology to determine appropriateness of resuming

G3: As G2 but with failure to respond to indicated interventions for a G 2 dermatitis In addition, treat with topical emollients, oral antihistamines, and medium- to high-potency topical corticosteroids If not resolved, interrupt treatment until skin AE has reverted to grade 1Ĭonsider initiating prednisone (or equivalent) at dosing 1 mg/kg, tapering over at least 4 weeks

G2: Inflammatory reaction that affects quality of life and requires intervention based on diagnosisĬonsider holding ICPi and monitor weekly for improvement. Treat with topical emollients and/or mild-moderate potency topical corticosteroids Counsel patients to avoid skin irritants and sun exposure G1: Symptoms do not affect the quality of life or controlled with topical regimen and/or oral antipruritic Instead, severity may be based on BSA, tolerability, morbidity, and duration. Grading according to CTCAE is a challenge for skin.

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Review full list of patient medications to rule out other drug-induced cause for photosensitivity

#MY KINGDOM FOR THE PRINCESS 2 LEVEL 4.9 SERIAL#

Consider expanding serologic studies or diagnostic work-up if other autoimmune conditions are considered based on signs, symptomsĬonsider clinical monitoring with use of serial clinical photography If needed, a biologic checkup, including a blood cell count and liver and kidney testsĭirected serologic studies if an autoimmune condition is suspected, such as lupus or dermatomyositis: a screening antinuclear antibody test, SS-A/Anti-Ro, SS-B/Anti-La if predominantly photodistributed/photosensitivity, antihistone, double-stranded DNA, and other relevant serologies. Rule out any other etiology of the skin problem, such as an infection, an effect of another drug, or a skin condition linked to another systemic disease or unrelated primary skin disorder Pertinent history and physical examination

Additional information is available at and 1.0 Skin Toxicitiesĭefinition: Erythema multiforme minor (a targetoid reaction in the skin and mucous membranes usually triggered by infections, such as herpes simplex viruses, but can be associated with an immune-related drug eruption and if progresses to erythema multiforme major, it and can be a harbinger of SCAR, such as SJS), lichenoid (resembling the flat-topped, polygonal, and sometimes scaly or hypertrophic lesions of lichen-planus), eczematous (inflammatory dermatitis characterized by pruritic, erythematous, scaly, or crusted papules or plaques on the skin, which is vulnerable to superinfection, psoriasiform, morbilliform, neutrophilic dermatoses, and others) In general, permanent discontinuation of ICPis is recommended with grade 4 toxicities, with the exception of endocrinopathies that have been controlled by hormone replacement. Some refractory cases may require infliximab or other immunosuppressive therapy. Corticosteroids should be tapered over the course of at least 4 to 6 weeks. Grade 3 toxicities generally warrant suspension of ICPis and the initiation of high-dose corticosteroids (prednisone 1 to 2 mg/kg/d or methylprednisolone 1 to 2 mg/kg/d). ICPi therapy may be suspended for most grade 2 toxicities, with consideration of resuming when symptoms revert to grade 1 or less. While management varies according to organ system affected, in general, ICPi therapy should be continued with close monitoring for grade 1 toxicities, with the exception of some neurologic, hematologic, and cardiac toxicities. Recommendations for specific organ system-based toxicity diagnosis and management are presented.

My kingdom for the princess 2 level 4.9