Cutaneous drug reactions

Weedon, David

doi:10.1016/b978-0-7020-3485-5.00021-8

Cited by 4 publications

(18 citation statements)

References 317 publications

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“…The histopathological features of photoallergic reactions are similar to those of allergic contact dermatitis, demonstrating papillary dermal oedema, a superficial and deep perivascular lymphohistiocytic infiltrate, and variable numbers of eosinophils (fig 3A). Early lesions demonstrate epidermal spongiosis, and late lesions, epidermal hyperplasia and parakeratosis 4 5. Acute phototoxic reactions are characterised by perivascular neutrophils, lymphocytes and histiocytes around the superficial and deep vascular plexuses, and variable transepidermal keratinocyte apoptosis.…”

Section: Predominantly Perivascular Dermatitismentioning

confidence: 99%

“…Acute phototoxic reactions are characterised by perivascular neutrophils, lymphocytes and histiocytes around the superficial and deep vascular plexuses, and variable transepidermal keratinocyte apoptosis. Chronic phototoxic reactions demonstrate variable epidermal disorganisation, dyskeratosis, hyperkeratosis, hypergranulosis, acanthosis, atrophy, melanocyte hyperplasia and increased melanin pigment 5 23. The dermal alterations include telangiectasia, elastotic degeneration and the appearance of stellate myofibroblasts 4 5 23 24…”

Section: Predominantly Perivascular Dermatitismentioning

confidence: 99%

“…Late lesions demonstrate confluent epidermal necrosis, vacuolar alteration, subepidermal separation, intra-epidermal clefts, more intense inflammation and greater erythrocyte extravasation (fig 5B). 1 4 5 29 Clues to the drug-induced aetiology include acrosyringeal concentration of keratinocyte necrosis and eosinophils within the dermal infiltrate 29. In addition, TEN has distinctive dermal sweat duct alterations, including basal cell hyperplasia and vacuolopathy with variable lymphocytic infiltration, apoptosis, necrosis and loss 1 4 29.…”

Section: Predominantly Perivascular Dermatitismentioning

confidence: 99%

“…The eruption is characterised by erythematous macules and papules that first appear on the trunk, in areas of pressure and foci of trauma, with subsequent symmetrical peripheral spread 5. Antibiotics (penicillins, cephalosporins, sulfonamides, amphotericin B and gentamicin), NSAIDs, barbiturates, benzodiazepines, carbamazepine, phenothiazines, phenytoin, lithium, allopurinol, captopril, thiazide diuretics, gold, oral antihyperglycaemic agents and quinidine have been implicated 3 – 5 46 47. Histologically, there is focal interface vacuolar dermatitis with scattered necrotic keratinocytes at the dermo-epidermal junction, dermal oedema and a superficial perivascular lymphocytic infiltrate with admixed eosinophils (fig 2B).…”

Section: Predominantly Perivascular Dermatitismentioning

confidence: 99%

“…Occurring more frequently in women, the incidence of CADRs increases with advancing age, the number of drugs being used, and concomitant HIV infection and other immunosuppressive states 2 3. The aetiology of CADRs may be immunological, encompassing all of the Gell and Coombs immune mechanisms, or non-immunological 4 5. CADRs may be confined to the skin or may be part of a systemic reaction.…”

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confidence: 99%

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Drug-induced cutaneous pathology

Ramdial¹,

Naidoo²

2009

J Clin Pathol

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Drug-induced cutaneous rashes, whether confined to the skin or part of a systemic disease, are characterised by a spectrum of inflammatory disease patterns that include perivascular dermatitis, nodular and diffuse dermatitis, vesiculobullous lesions, pustular eruptions, sclerodermoid reactions, vasculitis, folliculitis/perifolliculitis and panniculitis. While a single drug can elicit a range of reaction patterns, no reaction pattern is specific for a particular drug. Although the temporal link between initiation of drug therapy and the onset of the drug rash is critical to the diagnosis, drug reactions may also occur during the course of chronic drug ingestion. Clues to the drug-induced nature of the cutaneous eruption include the presence of overlapping histological reaction patterns and incongruent clinical and histopathological features. While eosinophils are an important tell-tale sign of a drug-induced reaction, they may also be conspicuous in skin rashes devoid of a drug association. Furthermore, eosinophils may be sparse or absent in some drug exanthems. Heightened awareness of the mimicry of a wide spectrum of cutaneous pathology by an ever-increasing range of therapeutic agents is pivotal to the diagnosis of drug-induced skin pathology.

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Section: Predominantly Perivascular Dermatitismentioning

confidence: 99%

Section: Predominantly Perivascular Dermatitismentioning

confidence: 99%

Section: Predominantly Perivascular Dermatitismentioning

confidence: 99%

Section: Predominantly Perivascular Dermatitismentioning

confidence: 99%

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confidence: 99%

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Drug-induced cutaneous pathology

Ramdial¹,

Naidoo²

2009

J Clin Pathol

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The mixed spongiotic and interface reaction pattern: A study of clinical and histopathologic findings

et al. 2022

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Background: Categorization of biopsy specimens into inflammatory reaction patterns is central to dermatopathologic assessment. Mixed inflammatory patterns are poorly characterized and may represent clinicopathologic challenges. The purpose of this study was to identify clinical and histopathologic findings associated with the mixed spongiotic-interface dermatitis (SID) histopathologic pattern.Methods: Fifty-one institutional biopsy specimens of SID were identified over a 2-year period by retrospective natural language search. Histopathologic and clinical features were identified. Results:The most common histopathologic features associated with SID were mild spongiosis (51%), focal vacuolar interface change (72%), lymphocytic exocytosis (92%), and superficial-dermal lymphocytic infiltrate (94%) with variable eosinophils (61%). Clinically, 80% of subjects presented with a symmetric morbilliform eruption.Polypharmacy (94%), immunosuppression (47%), and history of malignancy (47%) were common. The most common diagnoses were drug reaction (37%), possible drug reaction (12%), and viral exanthem (12%). Drug reaction with eosinophilia and systemic symptoms represented 25% of all confirmed cutaneous adverse drug reactions (CADR). Average time from drug initiation to symptom initiation was 20 days (SD: 22.3, range: 0-90); median disease duration was 25.5 days. Spongiotic vesicles and Langerhans cells were less common in patients with a strong clinicopathologic diagnosis of drug reaction compared to non-drug eruptions (p = 0.04). Conclusions:The mixed SID pattern is commonly encountered in CADR but may represent a more subacute course, implying consideration for inciting medication(s) started before the typical 7-to 14-day window.

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Considerations in geriatric dermatopathology

Brent,

Mancuso,

Smith

2023

Int J Dermatology

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This review provides an overview of considerations in geriatric dermatopathology. The nuances of specimen collection and reporting in this population, including the importance of obtaining adequate tissue, providing detailed clinical information and ethical considerations surrounding specimen collection will be discussed. The histopathologic changes associated with aging and the morphologic features of common lesions related to photoaging are outlined followed by a discussion of common interpretation pitfalls, specifically entities at risk of overinterpretation and those related to hyper‐ and hypopigmentation. Finally, the recent literature is reviewed regarding special cases and what this implies for future research both in dermatology and dermatopathology.

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Cutaneous drug reactions

Cited by 4 publications

References 317 publications

Drug-induced cutaneous pathology

Drug-induced cutaneous pathology

The mixed spongiotic and interface reaction pattern: A study of clinical and histopathologic findings

Considerations in geriatric dermatopathology

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