Drug induced exfoliative dermatitis: state of the art

Abstract

Drug induced exfoliative dermatitis (ED) are a group of rare and severe drug hypersensitivity reactions (DHR) involving skin and usually occurring from days to several weeks after drug exposure. Erythema multiforme (EM), Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Overall, T cells are the central player of these immune-mediated drug reactions. Here we provide a systematic review on frequency, risk factors, pathogenesis, clinical features and management of patients with drug induced ED.Electronic supplementary materialThe online version of this article (doi:10.1186/s12948-016-0045-0) contains supplementary material, which is available to authorized users.

Eosinophils from Physiology to Disease: A Comprehensive Review

“…Delayed or type IV drug hypersensitivity reactions (DHR) include immune-mediated reactions that occur more than one hour after the drug administration. Reactions severity range from self-limited maculopapular rashes that recover after drug suspension to toxic epidermonecrolysis, a life-threatening reaction with resulting organ damage and a high rate of mortality [ 211 , 212 ]. Delayed DHR (dDHR) are often accompanied by peripheral/tissue hypereosinophilia, thus qualifying themselves as type IVb reactions (see above).…”

Severe Cutaneous Adverse Reactions: The Pharmacogenomics from Research to Clinical Implementation

“…Major advances, such as the discovery of genetic predisposing factors, the clarification of HLA–drug–TCR interactions, and the identification of granulysin as a key mediator of cytotoxic T lymphocytes in SCARs, have been commonly implemented in the clinic, providing us with a sound foundation for disease prevention and early diagnosis. However, there is unfortunately no treatment guideline, highlighting the inadequacy of current accepted regimens [70]. In addition to therapeutic approaches directed against the Fas–FasL interaction [71] or the tumor necrosis factor (TNF)-α pathway [72,73,74], systemic corticosteroids have been the mainstay of SCAR therapies for a long time, which may be largely attributed by the notion that the immunopathogenesis of SCARs involves many cytotoxic and inflammatory mediators.…”

Allopurinol causing generalized exfoliative dermatitis: a case report

“…The correlation of the disease's etiology and its clinical presentation is usually weak since the drug reactions or changes to specific dermatosis are occasionally masked by exfoliative dermatitis changes that are non-specific. 12 Therefore, a conclusive correlation of a clinical histology might necessary to take series of biopsies. Even so, the significance of histopathology examination to ascertain the etiology of erythroderma remains to be clear.…”

“…Even so, the significance of histopathology examination to ascertain the etiology of erythroderma remains to be clear. 12,13 Based on the past empirical pieces of research and diagnoses, the common drug that has contributed for the occurrence of erythroderma is allopurinol. 1 Besides, other drugs have also been suggested to be the known causes of similar condition such as carbamazepine, phenytoin, penicillin, vancomycin, etc.…”