Eczematous Drug Eruptions

Eczematous drug eruptions mostly manageable with emollients and corticosteroids

“…Eczematous drug eruptions (EDEs) are eczema-like, spongiotic reactions which affect recipients of systemic medications [1]. While cutaneous reactions to drugs are common, EDEs appear to constitute up to 10% of these.…”

“…Three key mechanisms appear to underlie most cases of EDE, including immunomodulation of the skin, dry skin, which particularly affects the elderly (Table 1), and delayed hypersensitivity reactions (Table 2) [1]. EDEs are not necessarily the only, or the most common, cutaneous reactions to medications, and it can be difficult to clinically distinguish them from other rashes.…”

“…EDEs are not necessarily the only, or the most common, cutaneous reactions to medications, and it can be difficult to clinically distinguish them from other rashes. For example, tumour necrosis factor alpha (TNF-⍺) inhibitors most commonly cause psoriasiform dermatitis, which may look similar to an EDE, and immune checkpoint inhibitors (ICIs) most often cause a maculopapular rash, but either class of drugs can also cause an EDE (Table 1), sometimes simultaneously [1].…”

“…EDEs are not always classic eczematous rashes; there may be clinical overlaps with other cutaneous reactions (Table 1). Additionally, histology and molecular disease classification may reveal significant differences between EDEs and their non-EDE counterparts [4], which may support different management strategies [1]. Histological features of acute eczema in EDEs include spongiosis, increased eosinophils and a perivascular mononuclear infiltrate.…”

“…Histological features of acute eczema in EDEs include spongiosis, increased eosinophils and a perivascular mononuclear infiltrate. In prolonged eczema, spongiosis becomes more variable, with other changes occurring [1]. These may include epidermal hyperplasia and irregular elongation of rete ridges, with hyperkeratosis and parakeratosis [11].…”