Hydroxychloroquine-Induced Erythema Multiforme

Assalie, Nour Abou; Durcan, Robert; Durcan, Laura; Petri, Michelle

doi:10.1097/rhu.0000000000000417

Cited by 16 publications

(16 citation statements)

References 22 publications

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“…Hydroxychloroquine that has been used in 45% of all the cases (mentioned in Result) is one of the most likely medications to cause different skin rashes. Acute generalized exanthematous pustulosis (AGEP), erythroderma, urticaria, and erythema multiform are some of the skin lesions that have been reported in connection with hydroxychloroquine ( 79 – 81 ). However, Robustelli et al mentioned that the skin lesion developed 3 weeks after discontinuation of the drug ( 42 ).…”

Section: Discussionmentioning

confidence: 99%

Skin Manifestations in COVID-19 Patients: Are They Indicators for Disease Severity? A Systematic Review

et al. 2021

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Introduction: Until now, there are several reports on cutaneous manifestations in COVID-19 patients. However, the link between skin manifestations and the severity of the disease remains debatable. We conducted a systematic review to evaluate the temporal relationship between different types of skin lesions and the severity of COVID-19.Methods: A systematic search was conducted for relevant studies published between January and July 2020 using Pubmed/Medline, Embase, and Web of knowledge. The following keywords were used: “SARS-CoV-2” or “COVID-19” or “new coronavirus” or “Wuhan Coronavirus” or “coronavirus disease 2019” and “skin disease” or “skin manifestation” or “cutaneous manifestation.”Results: Out of 381 articles, 47 meet the inclusion criteria and a total of 1,847 patients with confirmed COVID-19 were examined. The overall frequency of cutaneous manifestations in COVID-19 patients was 5.95%. The maculopapular rash was the main reported skin involvement (37.3%) commonly occurred in middle-aged females with intermediate severity of the disease. Forty-eight percentage of the patients had a mild, 32% a moderate, and 20% a severe COVID-19 disease. The mild disease was mainly correlated with chilblain-like and urticaria-like lesions and patients with vascular lesions experienced a more severe disease. Seventy-two percentage of patients with chilblain-like lesions improved without any medication. The overall mortality rate was 4.5%. Patients with vascular lesions had the highest mortality rate (18.2%) and patients with urticaria-like lesions had the lowest mortality rate (2.2%).Conclusion: The mere occurrence of skin manifestations in COVID-19 patients is not an indicator for the disease severity, and it highly depends on the type of skin lesions. Chilblain-like and vascular lesions are the ends of a spectrum in which from chilblain-like to vascular lesions, the severity of the disease increases, and the patient's prognosis worsens. Those with vascular lesions should also be considered as high-priority patients for further medical care.

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Section: Discussionmentioning

confidence: 99%

Skin Manifestations in COVID-19 Patients: Are They Indicators for Disease Severity? A Systematic Review

et al. 2021

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“…Drug-related reactions were also included in the differential diagnosis. Although there are reports that link hydroxychloroquine to variable cutaneous adverse reactions such as erythema multiforme [ 15 ], morbilliform eruptions [ 16 ], and Steven's-Johnson syndrome [ 17 ], the majority of these have been described in patients with autoimmune underlying conditions, which were not present in our case. Additionally, hydroxychloroquine-related skin manifestations are usually noted after substantial cumulative doses (usually after a duration of treatment that exceeds 2-3 weeks) [ 18 ].…”

Section: Discussionmentioning

confidence: 79%

Cutaneous Vasculopathy in a COVID-19 Critically Ill Patient: A Histologic, Immunohistochemical, and Electron Microscopy Study

Kyriakoudi

Pontikis

Tsaraklis

et al. 2021

Case Reports in Critical Care

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We describe a critically ill, SARS-CoV-2 positive patient with respiratory failure and thrombotic/livedoid skin lesions, appearing during the course of the disease. The biopsy of the lesions revealed an occlusive, pauci-inflammatory vasculopathy of the cutaneous small vessels characterized by complement and fibrinogen deposition on vascular walls, pointing to a thrombotic vasculopathy. Transmission electron microscopy of the affected skin failed to reveal any viral inclusions. Clinical evaluation and laboratory findings ruled out systemic coagulopathies and disseminated intravascular coagulation, drug-induced skin reaction, and common viral rashes. Our hypothesis is that the, herein evidenced, microvascular occlusive injury might constitute a significant pathologic mechanism in COVID-19, being a common denominator between cutaneous and pulmonary manifestations.

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“…Severe cutaneous reactions to hydroxychloroquine are uncommon However, as in this case, drug hypersensitivity reactions often manifest in skin. Because of the extensive use of HCQ in the treatment of numerous dermatologic and rheumatologic conditions, because no specific therapy is available, and because correct diagnosis generally leads to spontaneous resolution once the causative drug is withdrawn, clinicians should keep the possibility of this rare but severe, extensive, and acute reaction in mind.…”

Section: Discussionmentioning

confidence: 90%