Abstract
Bullous pemphigoid (BP) is a rare autoimmune blistering disease that classically presents with pruritic, tense bullae on an erythematous base. Approximately 20% of patients with BP never develop bullae.1 In nonbullous pemphigoid (NBP), patients often experience severe pruritus with eczematous patches or urticarial plaques. The diagnosis of NBP represents a diagnostic challenge given its morphologic ambiguity. Clinical, histopathologic, serologic, and immunologic studies are necessary to establish a diagnosis.2 Programmed cell death 1 (PD-1) inhibitors block inhibitory T-cell signals to stimulate an effective antitumor response. This medication class is commonly associated with cutaneous immune-related adverse events, including BP-like eruptions.3, 4 Although sporadic NBP is well described in the dermatologic literature, to our knowledge, NBP developing in the setting of immune checkpoint inhibitors (ICI) has not been described.5 We report 4 cases of NBP in patients receiving PD-1 inhibitors for advanced malignancy.
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