Severe cutaneous adverse drug reactions

Abstract

Severe cutaneous drug reactions are one of the commonest medical challenges presenting to an emergency room in any hospital. The manifestations range from maculopapular rash to severe systemic symptoms like renal failure and cardiovascular compromise. Toxic epidermal necrolysis, erythroderma, drug rash with eosinophilia and systemic symptoms, acute generalised exanthematous pustulosis and drug induced vasculitis are the common cutaneous drug reactions which can have severe morbidity and even mortality. Careful history taking of the lag period after drug intake and associated symptoms, along with detailed examination of the skin, mucosa and various systems, help in early diagnosis of these reactions. Early stoppage of the incriminating drug, specific therapy including corticosteroids, cyclosporine and intravenous immunoglobulin depending on the case along with supportive therapy and local measures help in salvaging most patients. An overview of these important cutaneous drug reactions along with their management is being reviewed in this article.

Drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in vietnamese spontaneous adverse drug reaction database: A subgroup approach to disproportionality analysis

“…Many studies report female predominance, which is regarded as a risk factor . However, the reason why severe adverse reactions (especially SJS/TEN) are more common among women has not been elucidated to date .…”

“…Many studies report female predominance, which is regarded as a risk factor. 4,38,[45][46][47][48] However, the reason why severe adverse reactions (especially SJS/TEN) are more common among women has not been elucidated to date. 8 Our population-based study also shows that male patients were more likely to suffer SJS/TEN than their female counterparts-a marked difference compared to earlier studies of other population.…”

<p>Terapi lesi oral pasien sindrom Stevens-Johnson disertai lupus eritematosus sistemik</p><p>Oral lesion therapy in patients with Stevens-Johnson syndrome with systemic lupus erythematosus</p>

“…5,7 Obat-obatan yang berisiko tinggi terhadap terjadinya ADR termasuk OAT (obat anti tuberkulosis), antigout (allopurinol), antiepilepsi (carbamazepine, fenitoin, fenobarbital, lamotrigin), antibiotik (cotrimoxazole, sulfonamide, floroquinolone), anti inflamasi (sulfasalazine), AINS (antiinflamasi non-steroid) dan analgesik (parasetamol), ARV (antiretroviral virus), antihipertensi, antikonvulsan. [8][9][10] Efek yang ditimbulkan ADR dapat berupa eritema sampai efek samping berat yang mengancam jiwa seperti Stevens Johnson Sindrome (SJS) 11 dan ADR juga dapat memicu terjadinya sistemik lupus eritematous (SLE) pada penderitanya. [12][13][14][15] SJS merupakan reaksi mukokutan akut, ditandai oleh nekrosis epidermis luas dengan keterlibatan minimal 2 membran mukosa yang dipicu oleh obat, jarang karena infeksi dan keganasan.…”

General Aspects of Adverse Cutaneous Drug Reactions

“…Prevention of infection is essential as well as maintenance of fl uid and electrolyte balance and nutritional support. Systemic corticosteroids, cyclosporine, and intravenous immunoglobulins are the mainstays of therapy depending on the case [ 54 ], but the effectiveness of these therapies and other alternatives such as plasmapheresis and biologics is uncertain [ 53 ]. Prompt withdrawal of the suspected drugs may decrease mortality [ 55 ].…”