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

Table 1 Medications administered during hospitalisation

Drug name	Usage, dosage, and route of administration	Therapy duration
Camrelizumab	200 mg ivgtt qd	June 8, 2022
	200 mg ivgtt qd	June 29, 2022
Hydrotalcite chewable tablets	0.5 g po tid	July 22, 2022 - August 1, 2022
Methylprednisolone sodium Succinate injection	80 mg iv qd	July 21, 2022 - July 27, 2022
	80 mg iv mos	July 22, 2022
	80 mg iv mos	July 23, 2022
	60 mg iv mos	July 24, 2022
	60 mg iv mos	July 25, 2022
	40 mg iv mos	July 26, 2022
	20 mg iv mos	July 27, 2022
Dexamethasone sodium phosphate injection	18 mg ivgtt mos	July 28, 2022
	15 mg ivgtt mos	July 29, 2022
	15 mg ivgtt mos	July 30, 2022
	11.25 mg ivgtt mos	July 31, 2022
	11.25 mg ivgtt mos	August 1, 2022
Methylprednisolone	po qd	Discharge medication

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