20
Treatment
Table 1. Cutaneous Toxicities
1.3 Severe Cutaneous Adverse Reactions (SCAR)
Workup/Evaluation:
• Total body skin exam with attention to examining ALL mucous membranes, as well
as complete review of systems.
• Rule out any other etiolog y of the skin problem, such as an infection, an effect of
another drug or a skin condition linked to another systemic disease.
• A biological checkup including a complete blood count (CBC) with differential
test (DIFF), liver and kidney function tests, consider urinalysis (UA) in the context
of DRESS to assess for associated nephritis in addition to the blood work. If the
patient is febrile, blood cultures should be considered, as well. Skin biopsies to assess
for full thickness epidermal necrosis, as is seen in SJS/TEN, as well as other possible
etiologies like paraneoplastic pemphigus or other autoimmune blistering dermatoses
or other drug reactions, such as acute generalized exanthematous pustulosis (AGEP).
• Follow patients closely using serial clinical photography.
• If mucous membrane involvement or blistering is noted on the skin, consider early
admission to a burn center for further monitoring and management.
• Follow primer on monitoring for complicated cutaneous adverse drug reactions from
section 1.2.
Grading Management
All Grades In cases of suspected SJS or any mucous membrane
involvement (not including isolated stomatitis),
discontinue ICPi treatment and consult dermatolog y.
Monitor closely for improvement regardless of grade.
G1 and G2: Not Applicable
(N/A)
For the SCAR adverse reactions, there are no Grade 1
or 2 categories. If limited BSA is involved with bullae
or erosions, there should remain high concern that
this reaction will progress to Grade 3 or 4.
(cont'd)
