Progress in the Understanding of the Pathology and Pathogenesis of Cutaneous Drug Eruptions

Abstract

Cutaneous drug eruptions are among the most common adverse reactions to drug therapy. The etiology may reflect immunologic or nonimmunologic mechanisms, the former encompassing all of the classic Gell and Combs immune mechanisms. Cumulative and synergistic effects of drugs include those interactions of pharmacokinetic and pharmacodynamic factors reflecting the alteration by one drug of the effective serum concentration of another and the functions of drugs and their metabolites that interact to evoke cutaneous and systemic adverse reactions. Recent observations include the role of concurrent infection with lymphotropic viruses and drug effects that, through the enhancement of lymphoid blast transformation and/or lymphocyte survival and the contribution of intercurrent systemic connective tissue disease syndromes, promote enhanced lymphocyte longevity and the acquisition of progressively broadening autoantibody specificities. The latter are particularly opposite to drug-induced lupus erythematosus and to drug reactions in the setting of HIV infection. Specific common types of cutaneous drug eruptions will be discussed in this review. Successful management of cutaneous drug eruptions relies upon the prompt discontinuation of the causative medication; most drug eruptions have a good prognosis after this is accomplished. Oral or topical corticosteroids can be administered to aid in the resolution of some types of eruptions. Antihistamines or anti-inflammatory agents may also be administered for some eruptions.

Cutaneous drug eruptions: A 5-year experience

“…Morbilliform drug eruptions are the most common reactions produced by drugs, accounting for approximately 40%, followed by urticaria and angioedema, and account for up to 95% of cutaneous reactions. [8][9][10] We performed a literature search to identify previous studies documenting histologic findings in morbilliform drug eruptions. Recent journal articles and dermatopathology textbooks attempting to characterize morbilliform drug eruptions refer to only a single article from 1970, which briefly notes the histologic findings in 4 patients with cutaneous drug reactions caused by penicillin.…”

To study the pattern of suspected adverse drug reactions in patients coming to the department of dermatology in Gauhati Medical College and Hospital, Guwahati, Assam, India

“…common types of adverse reaction to drug therapy, with an overall incidence rate of 2-3% in hospitalized patients. 7,8 This study was therefore conducted to study the pattern of ADRs coming to the department of dermatology in a tertiary health care hospital. The objectives of the study were to assess the causality, severity, preventability, age distribution, sex distribution and the reactions occurring.…”

Cutaneous Adverse Drug Reactions-A Study of Clinical Patterns, Causality, Severity & Preventability

“…Cutaneous drug eruptions are one of the most common types of adverse reaction to drug therapy, with an overall incidence rate of 2-3% in hospitalized patients. [6,7] Almost any medicine can induce skin reactions, and certain drug classes, such as non-steroidal antiinflammatory drugs(NSAIDs), antibiotics and antiepileptic drugs, have drug eruption rates approaching 1-5%. [8]Most of the cutaneous drug reactions are not serious but some are severe and potentially lifethreatening.…”