Drug rash with eosinophilia and systemic symptoms vs toxic epidermal necrolysis: the dilemma of classification

Wolf, Ronni; Matz, Hagit; Marcos, Batsheva; Orion, Edith

doi:10.1016/j.clindermatol.2005.02.001

Cited by 58 publications

(31 citation statements)

References 41 publications

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“…DRESS usually includes skin eruption and systemic symptoms, such as fever, eosinophilia and internal organ damage [2]. Although SJS/TEN and DRESS are distinct diseases, both are thought to be T cell-mediated delayed-type hypersensitivities and share some clinical characteristics, such as causative agents [3,4]. However, the reasons for the different responses to the same drugs are not yet clear.…”

Section: Introductionmentioning

confidence: 99%

Clinical Features and Prognostic Factors in Severe Cutaneous Drug Reactions

Yang

Kang

Jung

et al. 2013

Int Arch Allergy Immunol

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Background: Severe cutaneous adverse reactions (SCARs) include Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS). SJS and TEN (SJS/TEN) and DRESS are thought to be different diseases; however, they share some clinical and laboratory features. Although SCORTEN serves as an excellent prognostic marker for SJS/TEN, there is still a need for development of other prognostic markers for SCARs. Methods: The study population consisted of 88 SCAR patients. Clinical characteristics and clinical manifestations were compared between SJS/TEN and DRESS. Risk factor analyses for prolonged hospitalization were performed. Results: Of the 88 patients, 41 were SJS/TEN and 47 were DRESS. Mortality rates of TEN and DRESS were 9.8 and 2.1%, respectively. Allopurinol and carbamazepine were the most common causes of both SJS/TEN and DRESS (34.7 and 62.9%, respectively). Some of the systemic presentations, such as fever and laboratory abnormalities were common in both phenotypes. Thrombocytopenia tended to be related to prolonged hospitalization (longer than 3 weeks) in SJS/TEN (odds ratio, OR = 5.1, 95% confidence interval, CI 0.8-31.8, p = 0.076). In DRESS patients, leukocytosis at presentation (OR 4.8, 95% CI 1.1-20.3, p = 0.03) was related to prolonged hospitalization. Conclusions: Clinical features of SCARs in a tertiary hospital in Korea were similar to those reported previously. SJS/TEN and DRESS shared some clinical and laboratory features. Thrombocytopenia for SJS/TEN and leukocytosis at presentation for DRESS may be useful prognostic markers for prolonged hospitalization.

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Section: Introductionmentioning

confidence: 99%

Clinical Features and Prognostic Factors in Severe Cutaneous Drug Reactions

Yang

Kang

Jung

et al. 2013

Int Arch Allergy Immunol

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“…Hastamızda döküntüler makülopapüler lezyonlara eşlik eden püstüler lezyonlar şeklinde klinik vermiştir. TEN'in, İHSS'nin deri bulguları arasında yer alması tartışmalı bir konudur 14,15 . Zonisamide kullanımı sonrası TEN gelişen olgularda HHV-tip 6 reaktivasyonu olduğu gösterilmiştir 16 .…”

Section: Discussionunclassified

Sulfasalazin İle Tetiklenen İlaçla İlişkili Hipersensitivite Sendromu

Saral¹,

Akay²,

Şanlı³

2013

Turkderm

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Türk derm-De ri Has ta lık la rı ve Fren gi Ar şi vi Der gi si, Ga le nos Ya yı ne vi ta ra f›n dan ba s›l m›fl t›r. Turk derm-Arc hi ves of the Tur kish Der ma to logy and Ve ne ro logy, pub lis hed by Ga le nos Pub lis hing. Özetİlaçla ilişkili hipersensitivite sendromu (İİHS), ilaç reaksiyonları arasında en tehlikelilerinden biridir. Sistemik organ tutulumları bu reaksiyonun mortalite ve morbiditesini arttırmaktadır. Lezyonlar en sık makülopapüler döküntü şeklinde ortaya çıkmakla birlikte, lezyon morfolojisi farklılık gösterebilir. Çoğunlukla aromatik antikonvulzanlarla ortaya çıkar. Ancak başka ilaçların da bu ilaç reaksiyonu patogenezinde rol oynayabileceği unutulmamalıdır. Erken tanı tedavide en önemli basamaktır. Burada sulfasalazin ile tetiklenen ve klinik olarak makülopapüler döküntüye eşlik eden püstüler lezyonlarla prezente olan bir İİHS olgusu sunmaktayız. Sum maryDrug-induced hypersensitivity syndrome (DIHS) is one of the most dangerous drug reactions. Mortality and morbidity is increased by consequent systemic organ involvement. Maculopapular eruptions are the most common lesions accompanying DIHS, however, the morphology of skin lesions may vary. The most common cause of DIHS is the use of aromatic anticonvulsant drugs. However, one must not forget that other drugs may also cause DIHS. Early recognition of the condition is the most important step in the treatment. Herein, we present a case of DIHS triggered by sulphasalazine and associated with pustular eruption and maculopapular eruption. (Turkderm 2013; 47: 123-5)

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“…Although the pathogenesis remains unclear, type IVb hypersensitivity reaction and a lack of effective drug metabolism, leading to an accumulation of harmful metabolites, are thought to play important roles in this condition [9][10]. It has also been suggested that human herpesvirus 6 infection is associated with DRESS syndrome [11].…”

Section: Discussionmentioning

confidence: 99%