Recent advances in the understanding of severe cutaneous adverse reactions

Abstract

Severe cutaneous adverse reactions (SCARs) encompass a heterogeneous group of delayed hypersensitivity reactions, which are most frequently caused by drugs. Our understanding of several aspects of SCAR syndromes has evolved considerably over the previous decade. This review explores evolving knowledge on the immunopathogenic mechanisms, pharmacogenomic associations, in-vivo and ex-vivo diagnostics for causality assessment and medication cross-reactivity data related to SCAR syndromes. Given the rarity and severity of these diseases, multidisciplinary collaboration through large international, national and/or multicentre networks to collect prospective data on patients with SCAR syndromes should be prioritized. This will further enhance a systematised framework for translating epidemiological, clinical, and immunopathogenetic advances into preventive efforts and improved outcomes for patients.

Drug‐induced liver injury is frequently associated with severe cutaneous adverse drug reactions: experience from two Australian tertiary hospitals

“…Similarly, infiltrates of CD8+ T cells have been detected on histopathological studies in patients with DILI to common drugs, such as amoxicillin/clavulanate and lamotrigine . Moreover, the role of herpes virus (Epstein–Barr virus, cytomegalovirus, human herpes viruses (HHV) 6 and 7) reactivation in the pathogenesis of cADRs has also recently been increasingly recognised . Lin et al .…”

Toxic Epidermicnecrolysis Two Cases Presentation

“…The most common cause is certain medications such as lamotrigine, carbamazepine, allopurinol, sulfonamide antibiotics, and nevirapine [1]. Other causes can include infections such as Mycoplasma pneumoniae and cytomegalovirus or the cause may remain unknown [2,3]. Risk factors include HIV/AIDS and systemic lupus erythematosus [1].…”

“…Treatment typically takes place in hospital such as in a burn unit or intensive care unit [2,6]. Efforts include stopping the cause, pain medication, and antihistamines [2,3]. Antibiotics, intravenous immunoglobulins, and corticosteroids may also be used [2,3].…”

Aetiopathogenesis of severe cutaneous adverse reactions (SCARs) in children: A 9‐year experience in a tertiary care paediatric hospital setting

“…To be more accurate, the acronym SCAR indicates a skin manifestation not exclusively related to drug intake. In fact, even if drugs are responsible for SCARs in >85%‐90% of cases, mainly for DRESS and AGEP, medications are not the only trigger and these diseases are the result of a complex interaction among different factors, including infectious agents and genetic susceptibility. For example, SJS may be induced by infectious agents ( Mycoplasma pneumoniae and viral infections) in up to 30% cases .…”

“…Diagnosing SCARs is not always easy. In a recent review, Adler et al summarize three major algorithms to assess drug causality in SCARs: the Naranjo scale, the Algorithm of Drug Causality for Epidermal Necrolysis (ALDEN) for SJS/TEN, the European Registry of Severe Cutaneous Adverse Reactions to Drugs (RegiSCAR) criteria, the Japanese group of Severe Cutaneous Adverse Reactions to Drugs (SCAR‐J) criteria for DRESS, the European Study of Severe Cutaneous Adverse Reactions scoring system for AGEP . In literature, the rate of hospital admissions for SCARs is reported to be from 0.3 up to 3.6/1000 and many epidemiological studies focused on SCARs analysed incidence, demographic characteristics of patients, possible triggers and mortality rate in a hospital setting .…”