Dermatitis bullosa caused by the immune checkpoint inhibitor camrelizumab: A case report

Table 2 Grading and management of immune-related dermatitis

Grading	Description	Recommendation for grade I	Recommendation for grade II	Recommendation for grade III
Grade 1	Asymptomatic; blisters covering < 10% of the body surface area (BSA); topical potent glucocorticoids	Emergency dermatology consultation; routine blood, liver, and kidney function, electrolytes, and C-reactive protein (CRP) tests
Grade 2	Painful blisters covering 10%-30% of the BSA; limited daily use of tools	Suspension of immune checkpoint inhibitor (ICI) treatment until the toxicity is < grade I; prednisone/methylprednisolone (0.5–1 mg/kg/d]); routine blood, liver, and kidney function, electrolyte, and CRP tests	Emergency dermatology consultation
Grade 3	Blisters covering > 30% of the BSA; significant limitation in self-care and daily life; Stevens–Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN)	Permanent discontinuation of treatment with ICIs; prednisone/methylprednisolone (1–2 mg/kg/d); hospital admission to the burn ward, intensive care unit monitoring or emergency consultation with a dermatologist, ophthalmologist, and urologist; test for routine blood indicators, liver and kidney functions, electrolyte levels, CRP, complement, and other relevant inflammatory factors	Skin biopsy when necessary
Grade 4	Blisters covering > 30% of the BSA; concurrent fluid and electrolyte abnormities; lethal SJS or TEN