Immunopathology of cutaneous drug eruptions

Abstract

Drugs may induce a wide range of skin reactions displaying a diversity of cutaneous inflammatory patterns. Histopathological clues for drug eruptions may be: eosinophils, lichenoid infiltrate and isolated keratinocytic apoptosis; a thorough medical history and correlation of clinical findings and dermatohistopathology are most important. Knowledge of typical adverse reactions to checkpoint inhibitors and their management is of great clinical interest as their use is rising steadily.

Single-Center Clinico-Pathological Case Study of 19 Patients with Cutaneous Adverse Reactions Following COVID-19 Vaccines

“…The variability between localized reactions (e.g., fixed drug eruption), on the one hand, and self-limiting generalized (e.g., maculopapular exanthema) to life-threatening generalized severe cutaneous ADR (e.g., Stevens-Johnson syndrome/toxic epidermal necrolysis), on the other, is astonishing. The pathological variability is not less impressive with reactions involving mainly the epidermis (e.g., symmetric drug-related interflexural exanthema), the epidermo-dermal junction (e.g., drug-induced cutaneous lupus erythematosus), the upper dermis (e.g., drug reaction with eosinophilia and systemic symptoms) or the subcutis (e.g., drug-induced septal panniculitis) [10]. Vaccines may be considered as specific drugs with the purpose to achieve a protective immune response; hence, they bear class-specific side effects [11].…”

Rare case of itraconazole induced SDRIFE (symmetrical drug‐related intertriginous and flexural exanthema)

“…Yet, the reason why these reactions are site-specific remains unclear. 11,12 The areas of distribution are prone to mechanical friction, heat, and sweat. However, apocrine sweat glands are exclusively found in those exact areas.…”

Bullous Pemphigoid in Patients Receiving Immune-Checkpoint Inhibitors and Psoriatic Patients—Focus on Clinical and Histopathological Variation

“…Co-inhibitory monoclonal antibodies of immune checkpoints on antigen presenting cells and T cells, i.e., immune checkpoint inhibitors (ICI), have revolutionized treatment of different types of cancer. Inhibitors of programmed cell death protein 1 (PD1) and pro-grammed cell death protein 1 ligand 1 (PDL1), among which nivolumab, pembrolizumab, cemiplimab, atezolizumab and avelumab are most commonly used, may shift the cellular immune response pattern towards a Th1 phenotype [21]. Not surprisingly, psoriasiform and lichenoid skin reactions are a common side effect of these drugs that occur in a large number of patients to a variable extent [22,23].…”