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Drug‐induced skin disease or cutaneous adverse drug reactions (CADRs) are terms that encompass the clinical manifestations of the skin, mucosae and adnexa induced by a drug or its metabolites. The skin is the organ most frequently affected by drug reactions, which may affect up to 10% of hospitalized patients and occur in 1–3% of multimedicated patients. Most CADRs are mild or self‐resolving conditions; however, 2–6.7% of could develop into potentially life‐threatening conditions. CADRs represent a heterogeneous field and can be diagnostically challenging as they may potentially mimic any dermatosis. Currently, there are between 29–35 different cutaneous drug‐reaction patterns reported ranging from mild dermatitis to an extensively burnt patient. The most frequently reported are maculopapular rash, urticaria/angioedema, fixed drug eruption and erythema multiforme. Less common but more severe patterns include erythroderma, drug reaction with eosinophilia and systemic symptoms, and Stevens–Johnson syndrome/toxic epidermal necrolysis spectrum. Almost any drug can induce a CADR, but antibiotics, nonsteroidal anti‐inflammatory drugs and antiepileptics are the most frequently involved. Different mechanisms are involved in the pathogenesis of CADRs, although in some cases, these remain still unknown. CADRs could be classified in different ways: (i) type A (augmented) or type B (bizarre); (ii) immediate or delayed; (iii) immune‐mediated or nonimmune‐mediated; (iv) nonsevere or life‐threatening; and (v) by their phenotype, including exanthematous, urticarial, pustular and blistering morphology. Recognizing a specific CADR will mostly depend on the ability of the physician to perform a detailed clinical examination, the proper description of the morphology of the skin lesions and supporting laboratory and/or skin biopsy findings.
Drug‐induced skin disease or cutaneous adverse drug reactions (CADRs) are terms that encompass the clinical manifestations of the skin, mucosae and adnexa induced by a drug or its metabolites. The skin is the organ most frequently affected by drug reactions, which may affect up to 10% of hospitalized patients and occur in 1–3% of multimedicated patients. Most CADRs are mild or self‐resolving conditions; however, 2–6.7% of could develop into potentially life‐threatening conditions. CADRs represent a heterogeneous field and can be diagnostically challenging as they may potentially mimic any dermatosis. Currently, there are between 29–35 different cutaneous drug‐reaction patterns reported ranging from mild dermatitis to an extensively burnt patient. The most frequently reported are maculopapular rash, urticaria/angioedema, fixed drug eruption and erythema multiforme. Less common but more severe patterns include erythroderma, drug reaction with eosinophilia and systemic symptoms, and Stevens–Johnson syndrome/toxic epidermal necrolysis spectrum. Almost any drug can induce a CADR, but antibiotics, nonsteroidal anti‐inflammatory drugs and antiepileptics are the most frequently involved. Different mechanisms are involved in the pathogenesis of CADRs, although in some cases, these remain still unknown. CADRs could be classified in different ways: (i) type A (augmented) or type B (bizarre); (ii) immediate or delayed; (iii) immune‐mediated or nonimmune‐mediated; (iv) nonsevere or life‐threatening; and (v) by their phenotype, including exanthematous, urticarial, pustular and blistering morphology. Recognizing a specific CADR will mostly depend on the ability of the physician to perform a detailed clinical examination, the proper description of the morphology of the skin lesions and supporting laboratory and/or skin biopsy findings.
Background: Acute generalized exanthematous pustulosis (AGEP) is a rare cutaneous drug reaction presenting with rapid-onset sterile pustules on edematous erythema. Case: A 12-year-old female patient with acute gastroenteritis was consulted with complaints of pruritic erythema and high fever developing with small pustules on the 2nd day of ceftriaxone treatment. Lab tests showed an elevated absolute neutrophil count and lymphopenia. Ceftriaxone was discontinued immediately. The fever went away within 24 hours. According to EuroSCAR, the diagnosis of AGEP was confirmed. The skin biopsy was compatible with AGEP. After 6 weeks, a patch test with ceftriaxone was performed. A strong positive reaction to ceftriaxone was detected. Three months later, amoxicillin, amoxicillin-clavulanate, clarithromycin, and trimethoprim/sulfamethoxazole patch tests were performed, all were negative, and provocation tests were also planned. Conclusion: AGEP is a severe cutaneous drug reaction. We wanted to emphasize that patch tests help identify the responsible drug and find a safe alternative.
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