Pearls and Pitfalls in the Treatment of SCARs and irAEs: Expanding Our Usage of Biologics and Other Systemics

The presentation by Dr. Rosenbach discussed the treatment of skin-related immune-related adverse events (irAEs) in oncology, emphasizing the effective application of biologics and systemic therapies. The talk highlighted the role of immune checkpoint inhibitors (ICIs) in malignancies, while also detailing their potential to cause skin adverse events, particularly in patients with melanoma. It pointed out the limitations of current NCCN guidelines that recommend a one-size-fits-all approach, advocating for treatment based on the morphology of the skin reactions. Dr. Rosenbach introduced new consensus guidelines developed through collaboration among dermatologists and oncologists, focusing on varied dermatologic issues associated with ICIs like erosive mucocutaneous eruptions, lichen planus-like reactions, and others, emphasizing the need for individualized treatment strategies. The speaker also highlighted the cautious use of systemic steroids, especially early in treatment, due to their association with poor outcomes. A range of systemic treatments, including acitretin, dupilumab, methotrexate, and understanding the role of biologics in conditions like bullous pemphigoid and psoriasis, were discussed. The necessity of careful patient assessment before initiating specific therapies was underscored, particularly in understanding the complexities of managing severe skin toxicities from cancer treatments. The concluding message emphasized the importance of evolving treatment paradigms in dermatology, especially within oncologic frameworks, to better manage irAEs and improve patient quality of life.