Severe skin complications in patients treated with antidepressants: a literature review

Abstract

Clinical manifestations of drug-induced skin reactions include a wide range of symptoms, from mild drug-induced exanthemas to dangerous and life-threatening generalized systematic reactions. Adverse drug reactions of low risk include phenomena such as drug-induced rashes, phototoxic reactions, eczemas and urticarias, which appear most often when the medication is being introduced. Drug-induced skin reactions to psychotropic medication are usually associated with antiepileptic drugs. However, a significant role can be assigned to selective serotonin reuptake inhibitors. The aim of this paper is to review a spectrum of severe skin complications in patients treated with antidepressants with the indication of their clinical monitoring and management.

SSRI‐induced severe adverse cutaneous reaction – a case report

“…AGEP may last for one to two weeks. 6 SSRI-induced severe adverse cutaneous reaction -a case report Andrew Byrne MBBCh, BAO, BA, MRCPsych, MMedSc, Sian Arkell MBBS, MRCPsych, Priya Bandi MBBS, MRCPsych.…”

“…The type I (toxic) reaction is dose related. 6 The rarer type II (idiosyncratic) reaction occurs in hypersensitive patients and is unpredictable. 9 Patients may experience flu-like symptoms, measles-like papulo-pustular eruptions and within 2 to 14 days, EM, pain, fever and chills.…”

“…Skin changes appear mainly on distal parts of upper and lower limbs, in mouth mucosa and genitourinary organs. 6 Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening multi-organ syndromes. They are characterised by epidermis death, mucosa laceration and organ damage.…”

“…Acute generalised exanthematous pustulosis (AGEP) 5. Drug-induced hypersensitivity syndrome (DIHS) 6 The first three syndromes above are considered to be three severities of the same syndrome. 7 These severe skin conditions may result in prolonged hospitalisation, substantial disability, and even death.…”

Is dermal melasma a phototoxic reaction? A case report

“…7,8 Skin reactions related to psychotropic drugs are usually associated with antiepileptic drugs. 9 However, in written literature severe skin reactions like erythema multiform, Stevens-Johnson syndrome (SJS); Lyell's Syndrome (Toxic Epidermal Necrolysis-TEN); Acute generalised exanthematous pustulosis (AGEP) caused by antidepressant including SSRIs, erythroderma, tanning, facial erythema, telangiectasia and photo distributed hyperpigmentation caused by only SSRI drugs have been reported. 5 In one case SJS/ TEN and in another case TEN was reported caused by fluoxetine.…”