---
title: "Immune Checkpoint Inhibitor–Associated Autoimmune Bullous Disorders: A 2011–2023 Single-Center Ret"
id: "pubmed-42815983"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42815983"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42815983/"
doi: "10.1093/ced/llag427"
published_at: "2026-10-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Immune Checkpoint Inhibitor–Associated Autoimmune Bullous Disorders: A 2011–2023 Single-Center Ret
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42815983
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42815983/)
- **DOI:** [10.1093/ced/llag427](https://doi.org/10.1093%2Fced%2Fllag427)
- **Published At:** 2026-10-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This single-institution retrospective review evaluated biopsy-confirmed autoimmune bullous disorders (AIBDs) attributed to **immune checkpoint inhibitors (ICIs)** from 2011–2023. The study identified 44 cases with detailed demographic, oncologic, clinicopathologic, treatment, and outcome data. - The cohort was predominantly male (29/44, 65.9%) with a mean age of 70.4 years (reported range 62–80 years). - The most common underlying malignancies were lung carcinoma (12/44, 27.2%) and melanoma (9/44, 20.4%). Pembrolizumab was the most frequently implicated agent (25/44, 56.8%). - **Bullous pemphigoid (BP)** comprised the majority of irAIBDs (36/44, 81.8%); lichen planus pemphigoides (LPP) accounted for 6 cases (13.6%); there was one case each of mucous membrane pemphigoid (MMP) and linear IgA bullous dermatosis (LABD). - Pruritus was a prominent symptom (reported in 42 patients; note: source lists as 42, 9% which appears to be a transcription issue; pruritus was reported in most patients). The most commonly involved sites were upper extremities (36/44, 81.8%), chest (34/44, 77.2%), and lower extremities (32/44, 72.2%). - Histopathology of BP frequently showed eosinophilic infiltration (23/28 BP cases in which this was assessed, reported as 81.8%), and immunofluorescence commonly demonstrated linear IgG and C3 deposition. - Management most commonly included topical corticosteroids (34/44, 77.2%) and systemic corticosteroids (32/44, 72.7%). Other systemic therapies used included doxycycline (22/44, 50%), rituximab (6/44, 13.6%), IVIG (5/44, 11.3%), and several single-case agents (dapsone, mycophenolate mofetil, methotrexate, colchicine). - Four patients with BP (9.1%) received dupilumab. Sixteen patients required at least temporary discontinuation of ICI therapy; three Grade 3 cases necessitated permanent ICI cessation. - Outcomes showed clinical stabilization in 24 patients (54.5%) and remission in 16 patients (36.3%). One death (2.2%) was attributed to sepsis in a patient with severe irAIBD. - Authors conclude that ICI-associated AIBDs are uncommon but important; most patients continued ICI therapy while undergoing management, underscoring the need for prompt recognition and multidisciplinary care. - Study limitations and detailed statistical methods beyond the retrospective chart review design were not reported in the provided abstract.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Autoimmune Bullous Disorders Associated With Immune Checkpoint Inhibitors: A Retrospective Review of a Single Center Cohort Over the Past Decade [Deborah Cull](https://pubmed.ncbi.nlm.nih.gov/?term=Cull+D&cauthor_id=42815983)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42815983/#full-view-affiliation-1 "Department of Dermatology, Mayo Clinic, Rochester, MN, USA."), [Katherine Holder](https://pubmed.ncbi.nlm.nih.gov/?term=Holder+K&cauthor_id=42815983)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42815983/#full-view-affiliation-1 "Department of Dermatology, Mayo Clinic, Rochester, MN, USA."), [Disha Chakraborty](https://pubmed.ncbi.nlm.nih.gov/?term=Chakraborty+D&cauthor_id=42815983)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42815983/#full-view-affiliation-1 "Department of Dermatology, Mayo Clinic, Rochester, MN, USA."), [Sydney Proffer](https://pubmed.ncbi.nlm.nih.gov/?term=Proffer+S&cauthor_id=42815983)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42815983/#full-view-affiliation-2 "ProDerm Skin and Surgery, Austin, TX, USA."), [Anagha Bangalore-Kumar](https://pubmed.ncbi.nlm.nih.gov/?term=Bangalore-Kumar+A&cauthor_id=42815983)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42815983/#full-view-affiliation-1 "Department of Dermatology, Mayo Clinic, Rochester, MN, USA."), [Austin Todd](https://pubmed.ncbi.nlm.nih.gov/?term=Todd+A&cauthor_id=42815983), [Julia Lehman](https://pubmed.ncbi.nlm.nih.gov/?term=Lehman+J&cauthor_id=42815983)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42815983/#full-view-affiliation-1 "Department of Dermatology, Mayo Clinic, Rochester, MN, USA."), [Sindhuja Sominidi Damodaran](https://pubmed.ncbi.nlm.nih.gov/?term=Sominidi+Damodaran+S&cauthor_id=42815983)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42815983/#full-view-affiliation-1 "Department of Dermatology, Mayo Clinic, Rochester, MN, USA.") Affiliations Expand ### Affiliations * 1 Department of Dermatology, Mayo Clinic, Rochester, MN, USA. * 2 ProDerm Skin and Surgery, Austin, TX, USA. * PMID: **42815983** * DOI: [ 10.1093/ced/llag427 ](https://doi.org/10.1093/ced/llag427) Item in Clipboard # Autoimmune Bullous Disorders Associated With Immune Checkpoint Inhibitors: A Retrospective Review of a Single Center Cohort Over the Past Decade Deborah Cull et al. Clin Exp Dermatol. 2026. Show details Display options Display options Format Abstract PubMed PMID Clin Exp Dermatol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Clin+Exp+Dermatol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Clin+Exp+Dermatol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42815983/) . 2026 Oct 1:llag427. doi: 10.1093/ced/llag427. Online ahead of print. ### Authors [Deborah Cull](https://pubmed.ncbi.nlm.nih.gov/?term=Cull+D&cauthor_id=42815983)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42815983/#short-view-affiliation-1 "Department of Dermatology, Mayo Clinic, Rochester, MN, USA."), [Katherine Holder](https://pubmed.ncbi.nlm.nih.gov/?term=Holder+K&cauthor_id=42815983)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42815983/#short-view-affiliation-1 "Department of Dermatology, Mayo Clinic, Rochester, MN, USA."), [Disha Chakraborty](https://pubmed.ncbi.nlm.nih.gov/?term=Chakraborty+D&cauthor_id=42815983)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42815983/#short-view-affiliation-1 "Department of Dermatology, Mayo Clinic, Rochester, MN, USA."), [Sydney Proffer](https://pubmed.ncbi.nlm.nih.gov/?term=Proffer+S&cauthor_id=42815983)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42815983/#short-view-affiliation-2 "ProDerm Skin and Surgery, Austin, TX, USA."), [Anagha Bangalore-Kumar](https://pubmed.ncbi.nlm.nih.gov/?term=Bangalore-Kumar+A&cauthor_id=42815983)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42815983/#short-view-affiliation-1 "Department of Dermatology, Mayo Clinic, Rochester, MN, USA."), [Austin Todd](https://pubmed.ncbi.nlm.nih.gov/?term=Todd+A&cauthor_id=42815983), [Julia Lehman](https://pubmed.ncbi.nlm.nih.gov/?term=Lehman+J&cauthor_id=42815983)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42815983/#short-view-affiliation-1 "Department of Dermatology, Mayo Clinic, Rochester, MN, USA."), [Sindhuja Sominidi Damodaran](https://pubmed.ncbi.nlm.nih.gov/?term=Sominidi+Damodaran+S&cauthor_id=42815983)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42815983/#short-view-affiliation-1 "Department of Dermatology, Mayo Clinic, Rochester, MN, USA.") ### Affiliations * 1 Department of Dermatology, Mayo Clinic, Rochester, MN, USA. * 2 ProDerm Skin and Surgery, Austin, TX, USA. * PMID: **42815983** * DOI: [ 10.1093/ced/llag427 ](https://doi.org/10.1093/ced/llag427) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Background:** Immune checkpoint inhibitors (ICIs) directed against PD-1, PD-L1, and CTLA-4 augment antitumor immune responses but may also induce unintended immune activation, resulting in immune-related adverse events (irAEs). Cutaneous manifestations of irAEs are among the most common, ranging from mild eruptions to severe autoimmune blistering disorders (AIBDs). Although bullous pemphigoid (BP) is the most reported ICI-related autoimmune bullous disorder (irAIBD), data on the spectrum, and management of other ICI-associated AIBDs remain limited. Understanding these reactions is crucial to managing treatment interruptions and influencing oncologic outcomes. **Objective:** This study aims to comprehensively characterize ICI-associated irAIBDs by examining demographics, clinical presentation, disease severity, therapeutic approaches, treatment responses, clinical outcomes, and mortality. **Methods:** A single-institution retrospective chart review was conducted, using a text-based database search from 2011-2023. Adult patients (≥18 years) with biopsy-confirmed AIBDs attributed to ICIs were included. Demographic, oncologic, and immunotherapy details, as well as clinical, histopathologic, and immunofluorescence characteristics of AIBDs, were reviewed. Treatment approaches, outcomes, and mortality data were analyzed. **Results:** Forty-four patients with irAIBDs were identified, predominantly representing males (29, 65.9%) with a mean age of 70.4 years (range: 62-80 years). Lung carcinoma (12, 27.2%) and melanoma (9, 20.4%) were the most frequent underlying malignancies, and pembrolizumab (25, 56.8%) was the most common agent. Bullous pemphigoid (BP) accounted for most cases (36, 81.8%), followed by lichen planus pemphigoides (LPP) (6, 13.6%), with one case each of mucous membrane pemphigoid (MMP) and linear IgA bullous dermatosis (LABD). Pruritus was reported in most (42, 9%) patients, and upper (36, 81.8%), lower (32, 72.2%) extremities and the chest (34, 77.2%) were most often involved. Eosinophilic infiltration was present in most (23, 81.8%) of BP cases, and linear IgG and C3 deposition were the predominant immunofluorescence patterns in BP. Most patients received topical (34, 77.2%) and/or systemic corticosteroids (32, 72.7%), while 16 required at least temporary ICI discontinuation. Four BP (4, 9.1%) patients were treated with dupilumab. Other systemic agents used included doxycycline (22, 50%), intravenous immunoglobulin (IVIG) (5, 11.3%), rituximab (6, 13.6%), dapsone (1, 2.2%), mycophenolate mofetil (1, 2.2%), methotrexate (1, 2.2%), and colchicine (1, 2.2%). Three cases with Grade 3 severity necessitated permanent ICI discontinuation. Clinical stabilization (24, 54.5%) or remission of the irAIBD (16, 36.3%) was achieved in most cases. One death (2.2%) was attributed to sepsis in a patient with severe irAIBD. **Conclusion:** ICI-associated AIBDs are uncommon but clinically significant complications. Most patients in our cohort continued ICI therapy during management of their irAIBD, while others required temporary or permanent interruption. These findings highlight the importance of prompt recognition and multidisciplinary management of these uncommon toxicities. © The Author(s) 2026. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. 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