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Clinical Reviews in Allergy & Immunology Dec 2021Adverse drug reactions involving the skin are commonly known as drug eruptions. Severe drug eruption may cause severe cutaneous adverse drug reactions (SCARs), which are... (Review)
Review
Adverse drug reactions involving the skin are commonly known as drug eruptions. Severe drug eruption may cause severe cutaneous adverse drug reactions (SCARs), which are considered to be fatal and life-threatening, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), acute generalized exanthematous pustulosis (AGEP), and drug reaction with eosinophilia and systemic symptoms (DRESS). Although cases are relatively rare, approximately 2% of hospitalized patients are affected by SCARs. There is an incidence of 2 to 7 cases/million per year of SJS/TEN and 1/1000 to 1/10,000 exposures to offending agents result in DRESS. However, the mortality rate of severe drug eruptions can reach up to 50%. SCARs represent a real medical emergency, and early identification and proper management are critical to survival. The common pathogenesis of severe drug eruptions includes genetic linkage with HLA- and non-HLA-genes, drug-specific T cell-mediated cytotoxicity, T cell receptor restriction, and cytotoxicity mechanisms. A multidisciplinary approach is required for acute management. Immediate withdrawal of potentially causative drugs and specific supportive treatment is of great importance. Immunoglobulins, systemic corticosteroids, and cyclosporine A are the most frequently used treatments for SCARs; additionally, new biologics and plasma exchange are reasonable strategies to reduce mortality. Although there are many treatment methods for severe drug eruption, controversies remain regarding the timing and dosage of drug eruption. Types, dosages, and indications of new biological agents, such as tumor necrosis factor antagonists, mepolizumab, and omalizumab, are still under exploration. This review summarizes the clinical characteristics, risk factors, pathogenesis, and treatment strategies of severe drug eruption to guide clinical management.
Topics: Drug Eruptions; Humans; Risk Factors; Severity of Illness Index
PubMed: 34273058
DOI: 10.1007/s12016-021-08859-0 -
Medicina (Kaunas, Lithuania) Sep 2021Fixed drug eruption (FDE) is a cutaneous adverse drug reaction characterized by the onset of rash at a fixed location on the body each time a specific medication is... (Review)
Review
Fixed drug eruption (FDE) is a cutaneous adverse drug reaction characterized by the onset of rash at a fixed location on the body each time a specific medication is ingested. With each recurrence, the eruption can involve additional sites. Lesions can have overlying vesicles and/or bullae, and when they cover a significant percentage of body surface area, the eruption is referred to as generalized bullous fixed drug eruption (GBFDE). Due to the widespread skin denudation that can be seen in this condition, GBFDE may be confused clinically with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). While treatments described for GBFDE include supportive care, topical and/or systemic steroids, and, recently, cyclosporine, the mainstay of management involves identifying and discontinuing the causative drug. This review article will provide an overview of FDE with an emphasis on its generalized bullous variant.
Topics: Diagnosis, Differential; Drug Eruptions; Humans; Recurrence; Skin; Stevens-Johnson Syndrome
PubMed: 34577848
DOI: 10.3390/medicina57090925 -
Ugeskrift For Laeger Apr 2018Drug eruption is defined as an adverse cutaneous eruption secondary to drug intake. The most frequent variation is a morbilliform exanthema, although the clinical... (Review)
Review
Drug eruption is defined as an adverse cutaneous eruption secondary to drug intake. The most frequent variation is a morbilliform exanthema, although the clinical presentations may vary widely. The diagnosis is clinical, why thorough medical history and assessment are essential for the risk stratification of possible adverse cutaneous reaction. In Western hospitals, the prevalence is estimated to be 2-3% of the patients. Identification of the condition is therefore important for all healthcare professionals.
Topics: Drug Eruptions; Humans; Risk Factors
PubMed: 29690993
DOI: No ID Found -
American Journal of Clinical Dermatology Jun 2020A fixed drug eruption (FDE) is a relatively common reaction associated with more than 100 medications. It is defined as a same-site recurrence with exposure to a... (Review)
Review
A fixed drug eruption (FDE) is a relatively common reaction associated with more than 100 medications. It is defined as a same-site recurrence with exposure to a particular medication. The primary approach and treatment for all types of FDEs are to identify and remove the causative agent, often accomplished by a thorough history of medication and other chemical exposures, and possibly prior episodes. The most common category of FDE, localized FDE, whether bullous or non-bullous, is self-limited. Although one can confirm the causative agent using oral challenge testing, it is not recommended due to the risk of severe exacerbation or possible generalization; patch testing is now preferred. Bullous FDE may resemble erythema multiforme. Treatment of localized FDE includes medication removal, patient counseling, and symptomatic relief. Failure to remove the causative agent in localized FDE can lead to recurrence, which is associated with increased inflammation, hyperpigmentation, and risk of a potentially lethal generalized bullous FDE (GBFDE), which may resemble Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Distinguishing GBFDE from SJS and TEN is salient and will be stressed: GBFDE has more rapid onset in 1-24 h rather than in weeks, less or no mucosal involvement, less or no systemic involvement, and a tendency for a more favorable prognosis; however, recent experience suggests it may be just as life-threatening. This review will provide a comprehensive update and approach to diagnosis and management.
Topics: Counseling; Diagnosis, Differential; Drug Eruptions; Erythema Multiforme; Humans; Palliative Care; Patch Tests; Prognosis; Recurrence; Severity of Illness Index; Skin; Time Factors
PubMed: 32002848
DOI: 10.1007/s40257-020-00505-3 -
CMAJ : Canadian Medical Association... Aug 2022
Topics: Drug Eruptions; Humans
PubMed: 35918090
DOI: 10.1503/cmaj.220049 -
Expert Review of Clinical Pharmacology Jul 2017Dapsone is a sulfone drug used to treat infectious conditions and also numerous dermatologic diseases. Fixed drug eruption is a distinctive adverse cutaneous reaction... (Review)
Review
Dapsone is a sulfone drug used to treat infectious conditions and also numerous dermatologic diseases. Fixed drug eruption is a distinctive adverse cutaneous reaction associated with the initial administration and subsequent delivery of a specific agent. Areas covered: The authors preformed a literature search using the following keywords: dapsone, fixed drug eruption, and adverse cutaneous drug reaction. Bibliographies were also reviewed for pertinent articles. The results were combed for relevant papers and reviewed. Articles pertaining to dapsone-associated fixed drug eruption were included. Expert commentary: The majority of cases of dapsone-associated fixed drug eruption in the literature come from Africa or India where there is a high prevalence of patients treated for leprosy. Characteristics of these cases are similar to fixed drug eruption described in the western literature, with differences in frequency of multiple versus solitary lesions. Dapsone-associated fixed drug eruption should be considered when reviewing the drug history of a patient with fixed drug eruption. In the case of darker pigmented individuals, multiple fixed drug eruption lesions may be more common. Multiple lesions may mimic Kaposi's sarcoma in human immunodeficiency virus positive patients. Dapsone-associated fixed drug eruption should be considered in the differential diagnosis of multiple hyperpigmented lesions.
Topics: Anti-Infective Agents; Dapsone; Dermatologic Agents; Diagnosis, Differential; Drug Eruptions; Humans; Leprostatic Agents; Leprosy
PubMed: 28434260
DOI: 10.1080/17512433.2017.1322508 -
Southern Medical Journal Nov 2014Fixed drug eruption (FDE) is a well-defined, circular, hyperpigmenting plaque that recurs as one or a few lesions always in fixed locations upon ingestion of a drug. FDE... (Review)
Review
Fixed drug eruption (FDE) is a well-defined, circular, hyperpigmenting plaque that recurs as one or a few lesions always in fixed locations upon ingestion of a drug. FDE commonly occurs on the genitals, lips, trunk, and hands. Although the lesions are distinctive, the diagnosis of FDE often is missed because it shares none of the characteristics of more common morbilliform drug rashes. The diagnosis can be confirmed by histopathologic examination of a small punch biopsy specimen. Drug avoidance is the mainstay of treatment, and antihistamines can reduce associated pruritus. Raising awareness of this condition will increase the likelihood of prompt diagnosis leading to resolution within days to weeks after the offending drug is discontinued.
Topics: Dermis; Diagnosis, Differential; Drug Eruptions; Humans
PubMed: 25365443
DOI: 10.14423/SMJ.0000000000000195 -
Contact Dermatitis Sep 2022
Topics: Dermatitis, Allergic Contact; Drug Eruptions; Humans; N-Methyl-3,4-methylenedioxyamphetamine
PubMed: 35452150
DOI: 10.1111/cod.14132 -
Journal of Nippon Medical School =... Nov 2022Apalutamide, an oral androgen receptor signaling inhibitor, is approved for the treatment of non-metastatic castration-resistant prostate cancer and metastatic prostate... (Review)
Review
Apalutamide, an oral androgen receptor signaling inhibitor, is approved for the treatment of non-metastatic castration-resistant prostate cancer and metastatic prostate cancer. In the international randomized placebo-controlled clinical trials, apalutamide was associated with a higher rate of rash than placebo. However, given that reports from a dermatological perspective are limited, the skin manifestations and histopathology of the skin lesions caused by apalutamide are largely unknown. Here, we report a case of apalutamide-induced drug eruption. A 66-year-old man developed itchy maculopapular erythema on the trunk and extremities 10 weeks after starting apalutamide for progressive prostate cancer. A biopsy specimen showed interface dermatitis with perivascular lymphocytic infiltration in the upper dermis. The lymphocyte transformation test was positive for apalutamide. The skin manifestations improved after discontinuation of apalutamide and treatment with topical corticosteroids and systemic prednisolone. A review of the dermatology literature on apalutamide-induced drug eruption yielded only six cases, including our case. Dermatologically, there were four cases of maculopapular rash and two of toxic epidermal necrolysis and histopathologically, there were three cases of interface dermatitis, two of epidermal necrosis, and one of spongiotic dermatitis. Four patients had peripheral eosinophilia. A lymphocyte transformation test was performed in three cases and was positive for apalutamide in all cases. Except for the two cases of toxic epidermal necrolysis, which were fatal, the skin eruptions appeared 10 weeks after starting apalutamide. Considering the increasing number of patients with prostate cancer being treated with apalutamide, cases of apalutamide-induced drug eruption need to be accumulated and analyzed.
Topics: Male; Humans; Aged; Stevens-Johnson Syndrome; Androgen Receptor Antagonists; Drug Eruptions; Exanthema; Prostatic Neoplasms
PubMed: 34526471
DOI: 10.1272/jnms.JNMS.2022_89-503 -
Journal of Investigational Allergology... 2020
Review
Topics: Anti-Inflammatory Agents, Non-Steroidal; Biopsy; Blister; Diagnosis, Differential; Disease Management; Drug Eruptions; Female; Humans; Middle Aged; Naproxen; Symptom Assessment; Tongue
PubMed: 32131994
DOI: 10.18176/jiaci.0502