Severe drug‐induced skin reactions: clinical features, diagnosis, etiology, and therapy

Abstract

Drugs can induce severe skin reactions that differ in clinical presentation, prognosis, and therapy. The spectrum of these reactions not only includes bullous reactions such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and generalized bullous fixed drug eruption (GBFDE) but also acute generalized exanthematous pustulosis (AGEP) and drug reaction with eosinophilia and systemic symptoms (DRESS). If AGEP or DRESS is suspected, the diagnosis should be confirmed by thorough clinical examination, a skin biopsy, and specific laboratory tests. Crucial for the patient's prognosis, the causative agent should be rapidly identified and discontinued. It is therefore important to know the most frequent triggers of severe drug reactions, some of which may induce various reaction patterns. Depending on the clinical diagnosis, symptomatic and adequate supportive therapy, as well as systemic immunomodulatory treatments are used. The prognosis in SJS/TEN is often poor and depends on the patient's age and underlying conditions as well as the extent of skin detachment. The prognosis of GBFDE is somewhat better, but recurrences may lead to more severe disease manifestations. In DRESS, protracted and recurrent courses have been described, whereas AGEP usually resolves without problems.

Pustulosis exantemática generalizada aguda asociada a Mycoplasma pneumoniae: reporte de un caso

“…El diagnóstico de la infección aguda por M. pneumoniae se realiza con técnicas serológicas (IgM), RPC o cultivos. Las técnicas serológicas (como la realizada en este caso) son las más usadas, pero se asocian a una alta tasa de falsos positivos por reacciones cruzadas o en períodos de alza epidémica (especificidad diagnóstica tan baja como 49%, según algunos estudios); además, tardan 7-10 días en hacerse positivos [3][4][5] . La RPC de muestra respiratoria es superior a la serología y es positiva de manera precoz 4 .…”

Associations between HLA class I and cytochrome P450 2C9 genetic polymorphisms and phenytoin-related severe cutaneous adverse reactions in a Thai population

“…Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.pharmacogeneticsandgenomics.com). most common causative drugs of cutaneous adverse drug reactions ranging from mild cutaneous reactions such as maculopapular rash, fixed-drug eruption, and urticaria to life-threatening severe cutaneous adverse reactions (SCAR) such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reactions with eosinophilia and systemic symptoms (DRESS) [3][4][5][6]. The etiology of SJS and TEN differs only in the extent of skin detachment relative to the body surface area, whereas DRESS is characterized by a generalized skin rash with fever, hematologic abnormalities, for example, eosinophilia, atypical lymphocytes, and systemic manifestations [7].…”

Generalized Bullous Fixed Drug Eruption: Case Report

“…Bazen GBFİE'de derin perivasküler eozinofil infiltrasyonunun ve bazen de geç dönemde nötrofil infiltrasyonunun gözlen-mesi TEN/ SJS'den histolojik olarak ayrımını sağla-yabilir. 8 Tekrarlayan ataklar daha yaygın ve daha şiddetli tutuluma sebep olabilmektedir. 7,8 Olgumuzda farklı olarak oral ve genital mukoza tutulumu mevcuttu.…”

“…8 Tekrarlayan ataklar daha yaygın ve daha şiddetli tutuluma sebep olabilmektedir. 7,8 Olgumuzda farklı olarak oral ve genital mukoza tutulumu mevcuttu. Bunlara ek olarak fiks ilaç erüpsiyonu için daha tipik olan koyu kırmızı plaklar üzerinde büller eşlik ediyordu.…”

“…5 Fiks ilaç erüpsiyonunda yama testi pozitifliği %40 oranında bildirilmiştir. 8 Biz de olgumuza klinik olarak tanı koyduk. Olgu kabul etmediği için yama testi yapı-lamadı.…”