Immunotherapy and Skin Side Effects | Dermatology | JAMA Dermatology | JAMA Network
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JAMA Dermatology Patient Page
June 2018

Immunotherapy and Skin Side Effects

JAMA Dermatol. 2018;154(6):744. doi:10.1001/jamadermatol.2018.0269

Immunotherapy is a type of cancer treatment that recruits the body’s natural defenses to fight cancer.

It is different from other “standard” cancer treatments such as chemotherapy, radiation therapy, and surgery in that it stimulates the body’s immune system to fight cancer directly. It can also help the body recognize cancer cells, decrease the chance of cancer spreading, or prevent cancer from coming back after treatment.


Because of how it works, immunotherapy can sometimes cause the immune system to attack healthy cells too, as a side effect. This can affect many different organs of the body. In some cases, side effects occur quickly, while others may take months to develop. The most common side effects include symptoms that feel like the flu (fatigue, fever, chills, muscle aches). Patients may also develop nausea, vomiting, or diarrhea.

Immunotherapy can also cause many different side effects that involve the mouth, hair, and skin. Mouth sores may make it difficult to eat or drink. Itching and rashes are the most common side effects on the skin. Hair loss may develop in round patches on the scalp or may lead to complete loss of all the hair on the body. Another side effect is loss of skin pigmentation. Rarely, firm bumps in the skin called granulomas may develop. Fluid-filled blisters in the skin may also develop and can be uncomfortable, or the blisters may break leaving open sores.

It is important to tell your doctor if you are experiencing side effects from immunotherapy. In some cases, the appearance of certain side effects can be a good sign by showing that the immune system is being stimulated, which means it is more likely that cancer is being attacked.


Your doctor will ask about your symptoms and may order specific tests to determine the organs affected by the immunotherapy. When the skin is involved, a small skin biopsy is sometimes performed. Sometimes you will be referred to specialists to handle the reaction in others organ systems.


Treatment will depend on the type of the reaction and the degree of discomfort it is causing. Topical steroids or, in some cases, oral steroids may be needed to control the skin reaction.

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Section Editor: Misha Rosenbach, MD
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Conflict of Interest Disclosures: None reported.