Adverse Events and Real-World Outcomes of Intravenous Immunoglobulin in Dermatologic Diseases: A 20-Year Cohort Study.

BACKGROUND: Intravenous immunoglobulin (IVIG) is widely used in dermatology for severe and refractory immune-mediated diseases; however, comprehensive real-world data regarding its effectiveness and safety across diverse dermatologic conditions remain limited. OBJECTIVE: To evaluate the clinical outcomes and adverse events associated with IVIG therapy in patients with dermatologic diseases treated in routine clinical practice. METHODS: A retrospective cohort study was conducted including 285 patients who received IVIG at a tertiary dermatology center between January 2001 and November 2021. Demographic characteristics, diagnoses, comorbidities, treatment responses, and immediate and delayed adverse events were analyzed. RESULTS: The majority of patients had autoimmune bullous diseases (61%). Favorable clinical outcomes were observed across disease groups, particularly in autoimmune bullous diseases and the Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) spectrum. Adverse events occurred in 44 patients (15.4%) and included both immediate and delayed reactions. Hypertension and flu-like symptoms were the most common immediate reactions, while renal impairment and thromboembolic events were the most significant delayed complications. Adverse events were not associated with the underlying dermatologic disease but were significantly more common in patients with comorbidities. CONCLUSION: IVIG was associated with favorable clinical outcomes and was generally well tolerated in this retrospective cohort; however, careful assessment of patient comorbidities and individualized infusion strategies may help minimize treatment-related adverse events.