Severe drug‐induced skin reactions: clinical pattern, diagnostics and therapy

Abstract

Summary The spectrum of severe drug‐induced skin reactions includes not only Stevens‐Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) but also generalized bullous fixed drug eruption (GBFDE), acute generalized exanthematous pustulosis (AGEP) and hypersensitivity syndrome (HSS), also called drug reaction with eosinophilia and systemic symptoms (DRESS). These reactions differ in clinical presentation as well as prognosis, causative agents and therapy. Therefore, the appropriate diagnostic measures should be undertaken rapidly, in order to prove the diagnosis. In addition to a thorough clinical examination, a skin biopsy should be taken and specific laboratory investigations should be done if AGEP or HSS/DRESS is suspected. Since these reactions are drug‐induced, the causative agent should be rapidly identified and withdrawn. Besides adequate supportive therapy, systemic immunomodulatory treatments may be considered. Despite intensive care management, the prognosis in SJS and TEN is often poor and influenced by the amount of skin detachment as well as the age of the patients and the pre‐existing underlying conditions. Severe sequelae may develop in survivors and affect especially mucosal sites. The prognosis of GBFDE is better but recurrent events may lead to more severe involvement. In HSS/DRESS sequelae have been also described as well as long lasting and recurrent courses, whereas AGEP usually heals without problems.

Cutaneous manifestation mimicking Stevens-Johnson syndrome in a critically ill patient: looks similar but totally different

“…Assessment is often difficult when mucous membrane involvement is not yet apparent. 3 Hypotensive episodes during septic shock may lead to reduced perfusion pressure to the skin and mucosa. This may cause pressure point areas to develop pressure sores.…”

“…The consensus definition should always be consulted with referral to a dermatologist or performance of a skin biopsy if there is any doubt. 3 An incorrect diagnosis of SJS may lead to a totally inappropriate spectrum of treatment such as cessation of appropriate lifesaving antibiotics and the commencement of steroid therapy that will increase the risk of infection and impair wound healing.…”

Generalized Bullous Fixed Drug Eruption: Case Report

“…8 Tekrarlayan ataklar daha yaygın ve daha şiddetli tutuluma sebep olabilmektedir. 7,8 Olgumuzda farklı olarak oral ve genital mukoza tutulumu mevcuttu. Bunlara ek olarak fiks ilaç erüpsiyonu için daha tipik olan koyu kırmızı plaklar üzerinde büller eşlik ediyordu.…”

Amoxicillin induced toxic epidermal necrolysis: a case report

“…body surface area (BSA) involved: <10% in SJS; >30% in TEN; 10 to 30% in SJS-TEN overlap. 3,4 SJS and TEN are immune-mediated reactions, due to various etiological factors like drugs, infections, malignancy, and radiation therapy. 3 The drugs commonly implicated as the cause of SJS/TEN are anticonvulsants, sulfonamides, non-steroidal anti-inflammatory drugs and antibiotics.…”