Cutaneous Drug Reactions in the Elderly

Abstract

Cutaneous adverse drug reactions comprise a significant proportion of all adverse drug reactions. They may mimic other dermatologic or systemic illnesses and may cause significant morbidity or mortality. Seven morphologic groups encompass the most commonly encountered cutaneous drug reaction syndromes: exanthematous (maculopapular), dermatitic/eczematous, urticarial, pustular, blistering, purpuric, and erythrodermic. Drug reactions may have significant downstream consequences for the older individual.

Purpuric Drug Eruption in a Patient with Atopic Dermatitis Treated with Dupilumab

“…Multi-morbidity and frailty are likely to increase susceptibility to adverse drug reaction ( 9 ). The current patient is 85 years old and has had hypertension for 2 years.…”

An inventory of medicinal products causing skin rash: Clinical and regulatory lessons

“…A rash is often the result of an underlying disease (1), but a variety of medicinal products have also been associated with rashes. An eruptive skin rash associated with fever or other systemic symptoms is sometimes described as an ‘exanthema’ (1) or ‘maculopapular rash’, although (as shown below), the term (or its derivation, ‘exanthematous eruptions’) is used to describe the most common form of cutaneous eruption, consisting in an acute and extensive eruption of small fixed erythematous spots that become whitish or pale when applying pressure (2).…”

“…Although drug rashes may be classified according to their mechanism of action, such classification is usually of little use in diagnosing and managing an undifferentiated rash in clinical settings. Therefore, a morphological classification in seven groups has been proposed for the cutaneous rashes most frequently encountered in the clinical practice, the first three being the most common and the last more rare: a) exanthema (maculopapular rash): simple exanthemas (typically maculopapular rash) or complex exanthemas (such as DRESS - drug-reaction with eosinophilia and systemic symptoms); b) dermatitis (eczema): phototoxic reactions, photoallergic reactions, primary dermatitis reactions and drug induced xerosis; c) urticarial reactions: anaphylactic and anaphylactoid reactions, acetylsalicylic acid associated urticarial (chronic urticarial exacerbation by aspirin), angioedema, urticarial vasculitis, serum-sickness-like reaction; d) pustular rash: acute generalized erythematous pustulosis (AGEP) and DRESS; e) blistering rash: fixed-drug eruption, Stevens-Johnson syndrome/toxic epidermal necro-lysis (SJS-TEN), drug-induced pemphigus, drug-induced bullous pemphigoid, pseudoporphyria, drug-induced linear IgA bullous dermatosis; f) purpuric rash: drug-induced vasculitis, warfarin-induced skin necrosis, heparin-induced skin necrosis; and g) Erythrodermic rash (2).…”

“…Although various narrative reviews have been published on rash and other adverse drug reactions in general (2,13,25–28), as well as for different therapeutic groups (29–33), no comprehensive review of rash as an adverse effect of medi-cines has been published. In the present study we report on our investigation of the frequency of rash as an adverse drug reaction, based on the information provided by SmPC.…”