Uncomplicated Drug-Induced Disseminated Exanthemas

Bircher, Andreas J.

doi:10.1159/000335617

Cited by 22 publications

(11 citation statements)

References 36 publications

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“…Many DHRs are considered systemic, involving not only the skin but possibly internal organs also 50 . Evaluation can be made with CBC, renal and liver function tests and urinalysis.…”

Section: Diagnosismentioning

confidence: 99%

Skin eruptions in children: Drug hypersensitivity vs viral exanthema

Tsabouri

Atanasković-Marković

2021

Pediatric Allergy Immunology

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Childhood rashes or exanthemas are common and are usually relatively benign. There are many causes of rash in children, including mainly viruses, and less often bacterial toxins, drugs, allergens and other diseases. Viral exanthema often appears while children are taking a medication in the course of a viral infection; it can mimic drug exanthema and is perceived as a drug allergy in 10% of cases. In the vast majority of cases, the distinction between virus‐induced and drug‐induced skin eruption during the acute phase is not possible. The drugs most commonly implicated are beta‐lactams (BL) and non‐steroidal anti‐inflammatory drugs (NSAIDs). Viruses, commonly Epstein‐Barr virus (EBV), human herpesvirus 6 (HHV6) and cytomegalovirus (CMV), and the bacterium, Mycoplasma pneumoniae, may cause exanthema either from the infection itself (active or latent) or because of interaction with drugs that are taken simultaneously. Determination of the exact diagnosis requires a careful clinical history and thorough physical examination. Haematological and biochemical investigations and histology are not always helpful in differentiating between the two types of exanthema. Serological and polymerase chain reaction (PCR) assays can be helpful, although a concomitant acute infection does not exclude drug hypersensitivity. A drug provocation test (DPT) is although considered the gold standard for the diagnosis and is not preferred by the patients. Skin tests are not well tolerated, and in vitro tests, such as the basophil activation test and lymphocyte transformation, are of low sensitivity and specificity and their relevance is debatable. Based on current evidence, we propose a systematic clinical approach for timely differential diagnosis and management of rashes in children who present a cutaneous eruption while receiving a drug.

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“…Many DHRs are considered systemic, involving not only the skin but possibly internal organs also 50 . Evaluation can be made with CBC, renal and liver function tests and urinalysis.…”

Section: Diagnosismentioning

confidence: 99%

Skin eruptions in children: Drug hypersensitivity vs viral exanthema

Tsabouri

Atanasković-Marković

2021

Pediatric Allergy Immunology

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“…KİR'in %95'ini oluşturan makülopapüler erüpsiyonlar veya diğer adıyla ekzantematöz ilaç reaksiyonları veya morbiliform ilaç döküntüsü daha önce duyarlanmamış hastalarda genellikle tedavi başlangıcından 7-14 gün içinde başlar [27]. Bu süre eğer hasta daha önce bu ilaçla duyarlı ise ilaç alımı sonrası 6-12 saate kadar düşmektedir [15,31]. En fazla penisilinler, sülfonamidler, sefalosporinler ve antiepileptik ilaçlarla indüklenen makülopapüler erüpsiyonlar Epstein-Barr virüs (EBV) başta olmak üzere viral infeksiyonların varlığında daha çok görülmektedir [28,12].…”

Section: Makülopapüler Döküntülerunclassified

“…Daha önce dermatolojik hastalığı olmayıp yeni ilaç kullanan bir çocukta ani başlayan döküntülü lezyonlarda KİR akla gelmelidir [10]. Şüpheli durumlarda ilk olarak kişisel ve ailesel allerji öyküsü, önceki hastalıklar ve kullanılan tüm ilaçlar ve dozları kaydedilmelidir [10,31] [13]. Advers ilaç reaksiyonlarının değerlendirilmesinde "Naranjo advers ilaç reaksiyonları ölçme skalası" (Tablo 3), en çok kullanılan değerlendirme ölçeklerinden biridir [42].…”

Section: çOcuklarda Görülen Ki̇r'da Tani-ayirici Tani Yaklaşimlariunclassified

“…İlaç reaksiyonlarının çoğu sistemik hipersensitivite reaksiyonları olduğu için kutanöz tutulum yanında internal semptomlara da neden olabilirler. Bu yüzden hastaları değerlendirirken gerekli görülen durumlarda laboratuvar incelemeleri yapılmalıdır [31]. Tam kan sayımı, biyokimyasal parametrelerin takibi ve şiddetli KİR varlığında radyografik tetkikler istenmelidir.…”

Section: çOcuklarda Görülen Ki̇r'da Tani-ayirici Tani Yaklaşimlariunclassified

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Cutaneous drug reactions in childhood

Öztürk

Erden²,

Can³

et al. 2014

J Clin Exp Invest

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Cutaneous Drug reactions (CDR) are adverse admissions or harmful effects of drugs according to the definition by the World Health Organization. One of the early lessons learned in dermatology training is "any drug, any rash." Drug-related cutaneous reactions can be daunting, even for the experienced dermatologist and pediatrics. There have been more than 25 different patterns described in the literature. The most commonly affected organs are the skin in drug reactions and dermatological examination is very important in the diagnosis for drug reactions. Cutaneous drug reactions should be distinguished from viral exanthema which is the most commonly seen in children, and it often is not easily. In treatment of cutaneous drug reactions, the first step is to immediately discontinue the susceptible drug. In this article, the approach to cutaneous drug reactions in children will be evaluated in accordance with current literature.

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“…[ 6 ] Pathogenetically, the appearance of cutaneous lesions during the SARS-CoV-2 infection can be explained by an immune response initiated by the viral nucleotides which activate Langerhans cells with the secondary involvement of keratinocytes (maculopapular, urticarial and chicken pox-like rashes), by microthrombi formation and cutaneous vasculopathy (chilblain lesions, livedo reticularis, erythema multiforme-like rash, gangrene), or by reaction to the medication administered (urticaria, erythroderma, erythema multiforme, etc.). [ 7 , 8 ]…”

Section: Introductionmentioning

confidence: 99%

Viral exanthema as manifestation of SARS-CoV-2 infection

2020

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Rationale: The clinical manifestations of the SARS-CoV-2 infection are mainly respiratory but the virus can cause a variety of symptoms. Dermatological findings are less well-characterized. Data is scarce on their timing, type and correlation with the immune response. Patient concerns: We present the case of SARS-CoV-2 infection in a previously healthy woman who presented with respiratory symptoms and developed anosmia, diarrhea, and an erythematous maculo-papular rash on day 15 from symptom onset. Diagnosis: The nasopharyngeal swab tested by real time PCR for COVID-19 was positive. We interpreted this as a viral exanthema likely caused by an immune response to SARS-CoV-2 nucleotides. Interventions: She was treated with Hydroxychloroquine, Azithromycin and Lopinavir/Ritonavir, and the rash with topical corticosteroids. Outcomes: All symptoms resolved except for anosmia which persisted for 6 weeks. At the 4- and 6-weeks follow-up the IgG titers for SARS-CoV-2 were high. Lessons: We must consider that SARS-CoV-2 has a multi-organ tropism. In our case, the SARS-CoV-2 infection had lung, nasopharyngeal, neurological, digestive, and skin manifestations. Identifying the different manifestations is useful for understanding the extent of SARS-CoV-2 infection. We not only present a rare manifestation but also suggest that cutaneous manifestations may correlate with immunity.

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Uncomplicated Drug-Induced Disseminated Exanthemas

Cited by 22 publications

References 36 publications

Skin eruptions in children: Drug hypersensitivity vs viral exanthema

Skin eruptions in children: Drug hypersensitivity vs viral exanthema

Cutaneous drug reactions in childhood

Viral exanthema as manifestation of SARS-CoV-2 infection

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