免疫检查点抑制剂（ICIs）在癌症患者中的使用频繁导致切叶型免疫相关不良事件。实际上，这些单克隆抗体与细胞毒性T淋巴细胞抗原-4和程序性细胞死亡-1/配体1结合，导致免疫系统对肿瘤细胞和自身抗原的非特异性激活。皮肤是最常受累的器官系统，尤其表现为炎症病变，如斑丘疹、苔藓样、银屑病样和湿疹样爆发。虽然较少见，但也有报道ICI诱导的自身免疫性水疱性疾病，估计总发病率不到5%。类似水疱性表现是主要表型，而苔藓样激疱、大疱性类天疱疮和粘膜脱屑性天疱疮在个案中已有描述。总体而言，它们有广泛的临床表现，并且常常相互重叠，导致延迟诊断。在这些情况下，实现皮肤毒性的适当控制通常需要免疫抑制系统疗法和/或中断ICI治疗，这在癌症管理背景下带来治疗挑战。在本研究中，我们基于一项多中心、回顾性、观察性研究在意大利进行了一系列病例研究，包括45例接受ICI治疗并发生ICI诱发的类水疱性疣。此外，我们进行了全面的文献回顾，以确定有关ICI诱导的自身免疫性水疱性疾病的报道。已经报告了多个寻找其潜在发病机制的理论，本研究旨在更好地了解迄今为止对这一问题的了解情况。 版权所有© 2023 Merli、Accorinti、Romagnuolo、Marzano、Di Zenzo、Moro、Antiga、Maglie、Cozzani、Parodi、Gasparini、Sollena、De Simone、Caproni、Pisano、Fattore、Balestri、Sena、Vezzoli、Teoli、Ardigò、Vassallo、Michelerio、Satta、Dika、Melotti、Ribero和Quaglino。

Cutaneous immune-related adverse events are frequently associated with immune checkpoint inhibitors (ICIs) administration in cancer patients. In fact, these monoclonal antibodies bind the cytotoxic T-lymphocyte antigen-4 and programmed cell death-1/ligand 1 leading to a non-specific activation of the immune system against both tumoral cells and self-antigens. The skin is the most frequently affected organ system appearing involved especially by inflammatory manifestations such as maculopapular, lichenoid, psoriatic, and eczematous eruptions. Although less common, ICI-induced autoimmune blistering diseases have also been reported, with an estimated overall incidence of less than 5%. Bullous pemphigoid-like eruption is the predominant phenotype, while lichen planus pemphigoides, pemphigus vulgaris, and mucous membrane pemphigoid have been described anecdotally. Overall, they have a wide range of clinical presentations and often overlap with each other leading to a delayed diagnosis. Achieving adequate control of skin toxicity in these cases often requires immunosuppressive systemic therapies and/or interruption of ICI treatment, presenting a therapeutic challenge in the context of cancer management. In this study, we present a case series from Italy based on a multicenter, retrospective, observational study, which included 45 patients treated with ICIs who developed ICI-induced bullous pemphigoid. In addition, we performed a comprehensive review to identify the cases reported in the literature on ICI-induced autoimmune bullous diseases. Several theories seeking their underlying pathogenesis have been reported and this work aims to better understand what is known so far on this issue.Copyright © 2023 Merli, Accorinti, Romagnuolo, Marzano, Di Zenzo, Moro, Antiga, Maglie, Cozzani, Parodi, Gasparini, Sollena, De Simone, Caproni, Pisano, Fattore, Balestri, Sena, Vezzoli, Teoli, Ardigò, Vassallo, Michelerio, Satta, Dika, Melotti, Ribero and Quaglino.