Drug-induced cutaneous pathology

Abstract

Drug-induced cutaneous rashes, whether confined to the skin or part of a systemic disease, are characterised by a spectrum of inflammatory disease patterns that include perivascular dermatitis, nodular and diffuse dermatitis, vesiculobullous lesions, pustular eruptions, sclerodermoid reactions, vasculitis, folliculitis/perifolliculitis and panniculitis. While a single drug can elicit a range of reaction patterns, no reaction pattern is specific for a particular drug. Although the temporal link between initiation of drug therapy and the onset of the drug rash is critical to the diagnosis, drug reactions may also occur during the course of chronic drug ingestion. Clues to the drug-induced nature of the cutaneous eruption include the presence of overlapping histological reaction patterns and incongruent clinical and histopathological features. While eosinophils are an important tell-tale sign of a drug-induced reaction, they may also be conspicuous in skin rashes devoid of a drug association. Furthermore, eosinophils may be sparse or absent in some drug exanthems. Heightened awareness of the mimicry of a wide spectrum of cutaneous pathology by an ever-increasing range of therapeutic agents is pivotal to the diagnosis of drug-induced skin pathology.

Organ-specific eosinophilic disorders of the skin, lung, and gastrointestinal tract

“…maculopapular rashes, erythema multiforme, acute generalized exanthematous pustulosis, pseudolymphomatous and granulomatous drug reactions), the presence of eosinophils in the skin is a quite striking finding 29. DRESS, also named hypersensitivity syndrome, presents with an acute, severe skin eruption that may develop from a maculopapular rash into erythroderma, as well as with fever, lymphadenopathy, hepatitis, blood eosinophilia, and other organ involvement due to hypereosinophilia 30.…”

Reacciones cutáneas adversas a antimicrobianos sistémicos en pacientes hospitalizados: estudio transversal analítico retrospectivo

“…Con respecto al período de latencia entre el consumo del fármaco y la aparición de lesiones cutáneas, el DRESS fue el grupo que presentó las latencias más prolongadas, hallazgo que es concordante con series publicadas [6][7][8] . En relación a los patrones histopatológicos, los hallazgos son concordantes a lo encontrado en estudios previos 9,10 , siendo la dermatitis perivascular superficial, con o sin espongiosis, el patrón más frecuente, seguidos de la presencia de dermatitis con eosinófilos y de dermatitis de interfase. Estos patrones no muestran predilección por algún tipo de ATM-cRAM en particular.…”

Chronic Eczematous Eruptions in the Aging

“…It is generally believed by dermatopathologists and dermatologists that a skin biopsy specimen showing both spongiotic and interface dermatitis suggests the possibility of a cutaneous drug hypersensitivity reaction. 5,6 We therefore performed a subgroup analysis in our study population to determine whether cases displaying spongiotic and interface dermatitis on biopsy specimens were more likely to have a true drug eruption compared with those without this specific histopathologic pattern. Because the power was low on the subgroup analysis, we believed it would be inappropriate to report a matched odds ratio for thiazides or CCBs.…”

“…In addition, a subgroup analysis of a possible association between cases with a skin biopsy pattern of spongiotic and interface dermatitis (thought to indicate drug hypersensitivity changes in the skin) and CEEA was performed. 5,6 Methods…”