Differentiating Immunotherapy-Related Skin Reactions, with Naveed Sami, MD

During an interview with HCPLive at the 2025 New Wave Dermatology Conference, Naveed Sami, MD, a board-certified dermatologist and professor of medicine for the UCF College of Medicine, discussed a variety of take-home messages from his “Cutaneous Effects of Immunotherapy” session.

In this particular interview segment, Sami was asked about ways to approach the diagnosis and differentiation of immunotherapy-related skin reactions. Specifically, he was asked about differentiating them from other dermatologic conditions.

“The approach is, number one, to have open communication with the oncologist, so that they have a patient and get them in as early as possible,” Sami explained. “...The second aspect is that we approach it the same as we would with any new dermatological condition that would present. A good history, was this present before, or have they had anything like this before? Then, even if they have, many conditions can look very similar at the very beginning. So a biopsy or using the tools that are necessary are crucial in terms of evaluating a patient [is important].”

Sami noted that such evaluations could include doing blood tests, especially if a patient has more of a hypersensitivity reaction, for example. If this is the case, Sami noted, then the appropriate blood tests for side effects, such as drug hypersensitivity syndrome, may be needed.

“There's a grading system, with grade one being mild, and it’s based on the body surface area involvement,” Sami said. “If it's less than 10%, it's grade one or mild. If it's between 10 and 30, it's moderate, and that's grade two. Anything greater than the body surface area of 30% is grade three, and grade four is life-threatening. So you're trying to first evaluate the grade of where the disease is presented, based on the symptoms and based on the grade.”

Sami noted that if a provider observes a grade 1 or early grade 2, as grade 2 has a wide range of 10% - 30%, then the treatment being used may be continued, potentially. Oral antihistamines over the counter and topical steroids, nonsteroidal ointments, can be used as much as possible to try to help with such symptoms, however.

“If that doesn't work for certain conditions where light treatment may be helpful, such as eczema, psoriasis, or lichen planus, we try to use non-systemic treatments, such as light treatment, to try to help prevent progression,” Sami explained. “If that is not beneficial, or if something is needed, it requires systemic treatment.”

To find out more about this session topic, view Sami’s full interview segment posted above.

The quotes used in this interview summary were edited for clarity.