Morbilliform Drug Eruptions

Ukoha, Uzoamaka T.; Pandya, Amit G.; Domínguez, Arturo R.

doi:10.1007/978-1-4471-6729-7_5

Cited by 4 publications

(16 citation statements)

References 23 publications

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“…The pathophysiology of MDE eruptions is incompletely understood and may vary by patient and drug. Most agree that MDE represents idiosyncratic, T-cell-mediated Type IV delayed-hypersensitivity reactions [ 7 , 9 ]. In some cases, antigen-presenting cells present drug haptens—a drug or drug metabolite bound to a larger carrier protein or peptide—to antigen-specific naive CD4+ and CD8+ T-cells [ 9 , 10 ].…”

Section: Pathophysiologymentioning

confidence: 99%

“…In some cases, antigen-presenting cells present drug haptens—a drug or drug metabolite bound to a larger carrier protein or peptide—to antigen-specific naive CD4+ and CD8+ T-cells [ 9 , 10 ]. This interaction induces a complex immune response involving immune cell proliferation, infiltration of the skin, production of inflammatory mediators (both type I and type II cytokines), and induction of cytotoxicity upon exposure to a drug-protein antigen deposited in the skin [ 7 , 11 , 12 , 13 ]. Alternatively, in the p-i (“pharmacologic interaction of drugs with immune receptors”) theory, drugs may trigger an immune response by direct, off-target interaction with immune receptors such as T-cell receptors (TCRs) or major histocompatibility complexes (MHCs) [ 7 , 10 ].…”

Section: Pathophysiologymentioning

confidence: 99%

“…The eruption typically begins 5–14 days after the causative medication is initiated but may occur weeks to months later. Resolution may occur spontaneously after 1–2 weeks or with cessation of the causative medication [ 7 ]. After resolution, desquamation and post-inflammatory hyperpigmentation are common, especially in patients with darker skin tones [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Resolution may occur spontaneously after 1–2 weeks or with cessation of the causative medication [ 7 ]. After resolution, desquamation and post-inflammatory hyperpigmentation are common, especially in patients with darker skin tones [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Histopathologic Features of Maculopapular Drug Eruption

Ernst

Giubellino

2022

Dermatopathology

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Background: Cutaneous adverse drug reaction (CADR) is common in both inpatient and outpatient clinical settings and has been associated with a large variety of medications. Drug reactions represent a significant burden to the healthcare system due to increased hospital stay durations and associated costs. Moreover, some of these reactions may be life-threatening. The most common clinical manifestation of a CADR is a maculopapular drug eruption (MDE). Due to its many clinical mimics and associations with a variety of histopathologic patterns, maculopapular drug eruption is difficult to definitively diagnose from both a clinical and histopathological perspective. Summary: We reviewed the clinical and histopathologic features of 327 cases of MDE from several studies in the literature and summarized characteristic histopathologic findings and their frequencies of occurrence. We found that the most common and suggestive histopathologic features of MDE were epidermal spongiosis, lymphocytic infiltrate, and occasional necrotic keratinocytes; interface change at the DEJ; superficial perivascular and interstitial lymphocytic infiltrate with or without eosinophils and neutrophils in the mid-to-deep dermis and mild papillary dermal edema; and dilation of superficial vessels. The presence of multiple histopathologic patterns within the same tissue specimen is also suggestive of MDE. This review and analysis suggest that a biopsy may improve the diagnostic accuracy by both establishing common and uncommon features associated with MDE and reviewing features that help to exclude other causes of maculopapular eruption. Key Message: Histopathologic criteria for the diagnosis of MDE, while not entirely specific, may aid in establishing a differential that includes a drug eruption. Thus, a biopsy can be a helpful diagnostic tool when MDE is suspected by demonstrating findings suggestive of MDE or by ruling out clinical mimics. However, biopsy results cannot be used in isolation as clinical-pathologic correlation is paramount in MDE.

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Section: Pathophysiologymentioning

confidence: 99%

Section: Pathophysiologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Histopathologic Features of Maculopapular Drug Eruption

Ernst

Giubellino

2022

Dermatopathology

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“…Classically, these eruptions appear 5 to 14 days after the initiation of the offending agent. 1 On histopathologic examination, dermal hypersensitivity reactions are characterized by a superficial perivascular lymphocytic infiltrate, often with admixed eosinophils. 2 We report an unusual case of a bullous drug reaction, histologically characterized by leukemic cells in a patient with new-onset acute myeloid leukemia (AML).…”

Section: Introductionmentioning

confidence: 99%