Eczematous Drug Eruptions

Blum, Amy E.; Burgin, Susan

doi:10.1007/s40257-021-00586-8

Cited by 14 publications

(33 citation statements)

References 172 publications

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“…Eczematous drug eruptions (EDEs) are eczema-like, spongiotic reactions which affect recipients of systemic medications [1]. While cutaneous reactions to drugs are common, EDEs appear to constitute up to 10% of these.…”

Section: Eczematous Drug Eruptions-it's All In the Namementioning

confidence: 99%

“…Three key mechanisms appear to underlie most cases of EDE, including immunomodulation of the skin, dry skin, which particularly affects the elderly (Table 1), and delayed hypersensitivity reactions (Table 2) [1]. EDEs are not necessarily the only, or the most common, cutaneous reactions to medications, and it can be difficult to clinically distinguish them from other rashes.…”

Section: Eruptions Have Three Key Pathophysiological Causesmentioning

confidence: 99%

“…EDEs are not necessarily the only, or the most common, cutaneous reactions to medications, and it can be difficult to clinically distinguish them from other rashes. For example, tumour necrosis factor alpha (TNF-⍺) inhibitors most commonly cause psoriasiform dermatitis, which may look similar to an EDE, and immune checkpoint inhibitors (ICIs) most often cause a maculopapular rash, but either class of drugs can also cause an EDE (Table 1), sometimes simultaneously [1].…”

Section: Eruptions Have Three Key Pathophysiological Causesmentioning

confidence: 99%

“…EDEs are not always classic eczematous rashes; there may be clinical overlaps with other cutaneous reactions (Table 1). Additionally, histology and molecular disease classification may reveal significant differences between EDEs and their non-EDE counterparts [4], which may support different management strategies [1]. Histological features of acute eczema in EDEs include spongiosis, increased eosinophils and a perivascular mononuclear infiltrate.…”

Section: Eruptions Have Three Key Pathophysiological Causesmentioning

confidence: 99%

“…Histological features of acute eczema in EDEs include spongiosis, increased eosinophils and a perivascular mononuclear infiltrate. In prolonged eczema, spongiosis becomes more variable, with other changes occurring [1]. These may include epidermal hyperplasia and irregular elongation of rete ridges, with hyperkeratosis and parakeratosis [11].…”

Section: Eruptions Have Three Key Pathophysiological Causesmentioning

confidence: 99%

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Eczematous drug eruptions mostly manageable with emollients and corticosteroids

Fenton

Kang

2021

Drugs Ther Perspect

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Eczematous drug eruptions (EDEs) constitute up to 10% of cutaneous drug reactions, with biologics and some newer cancer treatments and antivirals regularly implicated. EDEs are generally mild, although bacterial superinfection is a risk. Drug withdrawal and rechallenge, where practical, is the gold standard diagnostic test. Dry skin, cutaneous immunomodulation and sometimes type IV hypersensitivity reactions underlie EDEs and treatments reflect this, with most patients responding to emollients and corticosteroids. Eczematous drug eruptions-it's all in the nameEczematous drug eruptions (EDEs) are eczema-like, spongiotic reactions which affect recipients of systemic medications [1]. While cutaneous reactions to drugs are common, EDEs appear to constitute up to 10% of these. EDEs are generally mild and occur after long-term use of medication; exceptions are systemic contact dermatitis and photoallergic reactions, which usually erupt within days. This article discusses commonly implicated classes of medications and summarises the diagnosis and management of EDEs, as reviewed by Blum and Burgin [1].

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Section: Eczematous Drug Eruptions-it's All In the Namementioning

confidence: 99%

Section: Eruptions Have Three Key Pathophysiological Causesmentioning

confidence: 99%

Section: Eruptions Have Three Key Pathophysiological Causesmentioning

confidence: 99%

Section: Eruptions Have Three Key Pathophysiological Causesmentioning

confidence: 99%

Section: Eruptions Have Three Key Pathophysiological Causesmentioning

confidence: 99%

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Eczematous drug eruptions mostly manageable with emollients and corticosteroids

Fenton

Kang

2021

Drugs Ther Perspect

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

Gofman,

Tocci,

Fischer

et al. 2024

Dermatological Reviews

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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.

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