An Atypical Presentation of Lichen Planus-Like Reaction from Pembrolizumab

Table 1

Skin and subcutaneous tissue disorders management of different gradings based on CTCAE (Common Terminology Criteria for Adverse Events) [16].

Grading (CTCAE)	General Cutaneous Features	Steroids	Immunosuppressives	Management of Immunotherapy	Outpatient or Inpatient care
1	Covers <10% BSA, limited, asymptomatic	Not recommended	Not recommended	Continue	Outpatient
2	Covers 10-30% BSA, minimal to moderate symptoms	Topical or systemic steroids oral 0.5-1 mg/kg/d	Not recommended	Continue	Outpatient
3	Covers >30% BSA, moderate or severe symptoms, limiting self-care ADLs	Systemic steroids oral or IV 1-2 mg/kg/d for 3 days then to 1mg/kg/d	Can consider if unresolved after 3-5 days of steroids	Suspend, discuss risk/benefit with patient	Outpatient or Inpatient for IV steroids
4	>30% BSA and fluid/electrolyte abnormalities	Systemic IV methylprednisolone 1-2mg/kg/d for 3 days	Can consider if unresolved after 3-5 days of steroids	Discontinue permanently	Inpatient and possible ICU or burn unit

BSA: body surface area.