Cutaneous Drug Reactions in the Elderly

Young, James; Shear, Neil H.

doi:10.1007/s40266-017-0483-5

Cited by 13 publications

(4 citation statements)

References 202 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Multi-morbidity and frailty are likely to increase susceptibility to adverse drug reaction ( 9 ). The current patient is 85 years old and has had hypertension for 2 years.…”

Section: Discussionmentioning

confidence: 99%

Purpuric Drug Eruption in a Patient with Atopic Dermatitis Treated with Dupilumab

Wang¹,

Zheng²,

Tang³

et al. 2022

Acta Derm Venereol

View full text Add to dashboard Cite

show abstract

“…Multi-morbidity and frailty are likely to increase susceptibility to adverse drug reaction ( 9 ). The current patient is 85 years old and has had hypertension for 2 years.…”

Section: Discussionmentioning

confidence: 99%

Purpuric Drug Eruption in a Patient with Atopic Dermatitis Treated with Dupilumab

Wang¹,

Zheng²,

Tang³

et al. 2022

Acta Derm Venereol

View full text Add to dashboard Cite

show abstract

“…A rash is often the result of an underlying disease (1), but a variety of medicinal products have also been associated with rashes. An eruptive skin rash associated with fever or other systemic symptoms is sometimes described as an ‘exanthema’ (1) or ‘maculopapular rash’, although (as shown below), the term (or its derivation, ‘exanthematous eruptions’) is used to describe the most common form of cutaneous eruption, consisting in an acute and extensive eruption of small fixed erythematous spots that become whitish or pale when applying pressure (2).…”

Section: Introductionmentioning

confidence: 99%

“…Although drug rashes may be classified according to their mechanism of action, such classification is usually of little use in diagnosing and managing an undifferentiated rash in clinical settings. Therefore, a morphological classification in seven groups has been proposed for the cutaneous rashes most frequently encountered in the clinical practice, the first three being the most common and the last more rare: a) exanthema (maculopapular rash): simple exanthemas (typically maculopapular rash) or complex exanthemas (such as DRESS - drug-reaction with eosinophilia and systemic symptoms); b) dermatitis (eczema): phototoxic reactions, photoallergic reactions, primary dermatitis reactions and drug induced xerosis; c) urticarial reactions: anaphylactic and anaphylactoid reactions, acetylsalicylic acid associated urticarial (chronic urticarial exacerbation by aspirin), angioedema, urticarial vasculitis, serum-sickness-like reaction; d) pustular rash: acute generalized erythematous pustulosis (AGEP) and DRESS; e) blistering rash: fixed-drug eruption, Stevens-Johnson syndrome/toxic epidermal necro-lysis (SJS-TEN), drug-induced pemphigus, drug-induced bullous pemphigoid, pseudoporphyria, drug-induced linear IgA bullous dermatosis; f) purpuric rash: drug-induced vasculitis, warfarin-induced skin necrosis, heparin-induced skin necrosis; and g) Erythrodermic rash (2).…”

Section: Introductionmentioning

confidence: 99%

“…Although various narrative reviews have been published on rash and other adverse drug reactions in general (2,13,25–28), as well as for different therapeutic groups (29–33), no comprehensive review of rash as an adverse effect of medi-cines has been published. In the present study we report on our investigation of the frequency of rash as an adverse drug reaction, based on the information provided by SmPC.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

An inventory of medicinal products causing skin rash: Clinical and regulatory lessons

et al. 2019

View full text Add to dashboard Cite

A variety of medicinal products have been associated with rash and normally this information should be available in the Summary of Product Characteristics (SmPCs). Our study aimed to investigate the frequency of rash as an adverse drug reaction, based on the information provided by SmPCs of 1,048 single active substances (international non-proprietary names) authorized in the United Kingdom. Data on rash frequency was collected from each SmPC using automated searches based on selected keywords. Data analysis was carried out using R, v. 3.4. We found that over 90% of the medicines used orally or by injection may be associated with rash as an adverse event, the most common classes being protein kinase inhibitors, anticancer medicinal products, monoclonal antibodies, biologicals, antivirals and retinoids, with high variations in rash frequency for products within the same class, but also for products with the same active substance. Analysis of SmPCs revealed the need to increase homogeneity in reporting rash frequency, by using Council for International Organizations of Medical Sciences classification, and Medical Dictionary for Regulatory Activities coding in a more standardized manner, and also the need to include more safety endpoints in clinical trials and to use better the safety results for publication and updating the SmPCs.

show abstract

Eczematous Drug Eruptions: Identification and Management of Pharmacological Culprits in Primary Care

Gofman,

Tocci,

Fischer

et al. 2024

Dermatological Reviews

View full text Add to dashboard Cite

IntroductionEczematous drug eruptions (EDEs) can mimic common skin conditions like eczema or psoriasis, complicating diagnosis and treatment. These eruptions often present as papular or vesicular lesions, sometimes pruritic, with scaling and crusting. EDEs can manifest anywhere from days to years after initiating medications commonly prescribed in the primary care setting such as calcium channel blockers, ACE inhibitors, ARBs, thiazides, and statins. Misdiagnosis can lead to prolonged patient discomfort and unnecessary treatments. This review emphasizes the importance of accurate differentiation between EDEs and other dermatoses for improved patient outcomes.ObjectiveThis review aims to aid clinicians in the differentiation of EDEs from clinically similar conditions, such as eczema and psoriasis. It focuses on identifying commonly prescribed medications in primary care settings that trigger EDEs, discusses diagnostic strategies, and explores effective treatment options for managing these eruptions.MethodsA comprehensive literature review was conducted using databases such as PubMed, Google Scholar, and the Cochrane Library, covering the period from January 1980 to January 2023. The search included terms like “eczematous,” “drug eruption,” “medication,” “drug induced,” “skin reactions,” “adverse cutaneous,” and “side effects.” Studies selected for review included literary reviews, systematic reviews, case reports, and case series focusing on the pharmacological agents responsible for EDEs. Articles were selected based on their focus on primary care medications and their connection to EDEs.ResultsThe review identified a broad spectrum of medications implicated in EDEs, including calcium channel blockers, ACE inhibitors, ARBs, thiazides, and statins. Among these, calcium channel blockers were the most frequently associated with chronic, diffuse, and pruritic scaly papules and plaques. Other common offenders include ACE inhibitors and ARBs, which primarily trigger eczema‐like rashes in elderly patients. Thiazide diuretics were associated with photosensitivity reactions leading to eczematous eruptions. Statins were found to compromise the skin barrier, contributing to the development of eczematous reactions, particularly in older individuals. The histopathological findings across cases frequently showed spongiosis, eosinophilic infiltrates, and acanthosis, complicating the differentiation from eczema without a thorough medication history.ConclusionsEarly recognition and differentiation of EDEs from common dermatoses, such as eczema or psoriasis, are essential for effective treatment. The review underscores the importance of maintaining a high index of suspicion for drug‐induced eruptions in patients on common cardiovascular medications. Prompt discontinuation of the offending drug, combined with alternative treatments, can significantly improve patient outcomes. Dermatologists and primary care providers should collaborate to optimize treatment, particularly when polypharmacy is a factor. Further research is needed to improve the understanding of the mechanisms behind EDEs and to refine diagnostic strategies, thus minimizing patient morbidity.

show abstract

Cutaneous Drug Reactions in the Elderly

Cited by 13 publications

References 202 publications

Purpuric Drug Eruption in a Patient with Atopic Dermatitis Treated with Dupilumab

Purpuric Drug Eruption in a Patient with Atopic Dermatitis Treated with Dupilumab

An inventory of medicinal products causing skin rash: Clinical and regulatory lessons

Eczematous Drug Eruptions: Identification and Management of Pharmacological Culprits in Primary Care

Contact Info

Product

Resources

About