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Australian Family Physician Jul 2011Drug reactions are a common cause of rashes and can vary from brief, mildly annoying, self limiting rashes to severe conditions involving multiple organ systems. (Review)
Review
BACKGROUND
Drug reactions are a common cause of rashes and can vary from brief, mildly annoying, self limiting rashes to severe conditions involving multiple organ systems.
OBJECTIVE
This article outlines an approach to exanthems that may be related to drug reactions and details appropriate management.
DISCUSSION
Rashes related to drug reactions are both nonallergic and allergic. Nonallergic rashes are usually predictable and may be avoidable. Allergic rashes include morbilliform erythema, urticaria and angioedema, erythema multiforme and vasculitic rashes. The vast majority of cases are rapidly resolving and self limiting once the offending agent is removed. Early recognition and supportive measures are the keys to care in the majority of cases. However, an awareness of serious drug reactions (Stevens- Johnson syndrome and toxic epidermal necrolysis), which are potentially life threatening conditions and require immediate specialist assessment and treatment in hospital, is important.
Topics: Complementary Therapies; Drug Eruptions; Erythema Multiforme; Exanthema; Humans; Urticaria
PubMed: 21743852
DOI: No ID Found -
Frontiers in Immunology 2023Graves' disease (GD) and drug eruption are closely associated and frequently observed in the clinical setting. However, it remains unclear whether a causal relationship...
BACKGROUND
Graves' disease (GD) and drug eruption are closely associated and frequently observed in the clinical setting. However, it remains unclear whether a causal relationship exists between these two conditions. The aim of the study is to investigate whether GD is causal to drug eruptions using two-sample Mendelian randomization.
METHODS
We launched a two-sample MR to investigate whether GD is causal to drug eruption using Genome-wide association study (GWAS) summary data from Biobank Japan and FinnGen. Genetic variants were used as instrumental variables to avoid confounding bias. Statistical methods including inverse variance weighted (IVW), weighted median, MR-Egger, and MR-PRESSO were conducted to identify the robustness of the causal effect.
RESULTS
Genetically predicted GD may increase the risk of drug eruption by 30.3% (OR=1.303, 95% CI 1.119-1.516, p<0.001) in the Asian population. In European populations, GD may increase the generalized drug eruption by 15.9% (OR=1.159, 95%CI 0.982-1.367, p=0.080).
CONCLUSIONS
We found GD is potentially causal to drug eruption. This finding expanded the view of the frequently observed co-existence of GD and adverse drug reactions involving the skin. The mechanism remains for further investigation.
Topics: Humans; Genome-Wide Association Study; Mendelian Randomization Analysis; Drug Eruptions; Skin; Graves Disease
PubMed: 38077385
DOI: 10.3389/fimmu.2023.1267814 -
Allergology International : Official... Apr 2022Non-HIV immune reconstitution inflammatory syndrome (non-HIV IRIS) is associated with the recovery from an immunocompromised condition. It is defined as inflammatory... (Review)
Review
Non-HIV immune reconstitution inflammatory syndrome (non-HIV IRIS) is associated with the recovery from an immunocompromised condition. It is defined as inflammatory disorders caused by antigens, including drugs or pathogenic microorganisms present prior to immune recovery, or by the exacerbation of an inflammatory disorder that was already present. Drug-induced hypersensitivity syndrome is a prototype of IRIS, and the pathophysiology of non-HIV IRIS can be recognized in several disorders treated with corticosteroids, immunosuppressants, molecular-targeted drugs, TNF-α antibody drugs, immune checkpoint inhibitors, and dipeptidyl peptidase-4 inhibitors. This review focuses on the relationship between the immune mechanism of non-HIV IRIS and drug allergies, especially severe drug eruption. The antigen recognition mechanism in drug allergy varies depending on the clinical type and the causative drug. The p-i concept is the main mechanism in severe drug eruption such as Stevens-Johnson syndrome/toxic epidermal necrolysis, and drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Lymphocytes activated by an antigen other than a drug, such as a virus, can also develop drug allergy by the loose binding of drugs with immune receptors of T cells or human leukocyte antigen. Therefore, fluctuations in the immune environment affect the onset of severe drug eruption. Novel agents that cause major changes in immunity have been marketed mainly for autoimmune diseases and malignant tumors; therefore, it is necessary to consider their effects when treating severe drug eruptions. Moreover, although a list of diagnostic criteria for this syndrome has been drafted, predictive and diagnostic biomarkers for this syndrome needs to be urgently developed.
Topics: Adrenal Cortex Hormones; Drug Hypersensitivity Syndrome; Eosinophilia; Humans; Immune Reconstitution Inflammatory Syndrome; Stevens-Johnson Syndrome
PubMed: 35236619
DOI: 10.1016/j.alit.2021.12.002 -
CMAJ : Canadian Medical Association... Dec 2022
Topics: Humans; Glucosides; Benzhydryl Compounds; Drug Eruptions; Hypoglycemic Agents; Diabetes Mellitus, Type 2; Dose-Response Relationship, Drug; Drug Therapy, Combination; Treatment Outcome
PubMed: 36511861
DOI: 10.1503/cmaj.220934 -
Indian Journal of Dermatology,... 2022
Topics: Humans; Mucinosis, Follicular; Mycosis Fungoides; Drug Eruptions; Carbamazepine; Skin Neoplasms
PubMed: 35962486
DOI: 10.25259/IJDVL_136_2022 -
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 -
Singapore Medical Journal Mar 2006Drug rash with eosinophilia and systemic symptoms (DRESS) is a hypersensitivity syndrome. It presents with severe cutaneous eruption, fever, lymphadenopathy, hepatitis,...
Drug rash with eosinophilia and systemic symptoms (DRESS) is a hypersensitivity syndrome. It presents with severe cutaneous eruption, fever, lymphadenopathy, hepatitis, haematological abnormalities with eosinophilia, atypical lymphocytes and may also involve other organs. The multi-organ involvement differentiates this entity from other common drug eruptions. DRESS has been associated with higher morbidity and mortality compared to other adverse drug reactions. Sulphasalazine hypersensitivity is rarely reported and we wish to highlight a case of sulfasalazine-induced DRESS presenting as leukocytoclastic vasculitis, hepatitis and haematological abnormalities in a 49-year-old Indian woman.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Drug Eruptions; Eosinophilia; Exanthema; Female; Humans; Middle Aged; Sulfasalazine; Syndrome
PubMed: 16518561
DOI: No ID Found -
Contact Dermatitis Sep 2022
Topics: Dermatitis, Allergic Contact; Drug Eruptions; Humans; N-Methyl-3,4-methylenedioxyamphetamine
PubMed: 35452150
DOI: 10.1111/cod.14132 -
International Journal of Molecular... Jul 2021In accordance with the development of human technology, various medications have been speedily developed in the current decade. While they have beneficial impact on... (Review)
Review
In accordance with the development of human technology, various medications have been speedily developed in the current decade. While they have beneficial impact on various diseases, these medications accidentally cause adverse reactions, especially drug eruption. This delayed hypersensitivity reaction in the skin sometimes causes a life-threatening adverse reaction, namely Stevens-Johnson syndrome and toxic epidermal necrolysis. Therefore, how to identify these clinical courses in early time points is a critical issue. To improve this problem, various biomarkers have been found for these severe cutaneous adverse reactions through recent research. Granulysin, Fas ligands, perforin, and granzyme B are recognized as useful biomarkers to evaluate the early onset of Stevens-Johnson syndrome and toxic epidermal necrolysis, and other biomarkers, such as miRNAs, high mobility group box 1 protein (HMGB1), and S100A2, which are also helpful to identify the severe cutaneous adverse reactions. Because these tools have been currently well developed, updates of the knowledge in this field are necessary for clinicians. In this review, we focused on the detailed biomarkers and diagnostic tools for drug eruption and we also discussed the actual usefulness of these biomarkers in the clinical aspects based on the pathogenesis of drug eruption.
Topics: Animals; Biomarkers; Diagnosis, Differential; Drug Eruptions; Humans; Stevens-Johnson Syndrome
PubMed: 34299145
DOI: 10.3390/ijms22147527 -
Dermatology Online Journal Aug 2009A 78-year-old man presented with an eight-month history of folliculocentric, pink, hyperkeratotic papules and plaques with thick white scale that involved the entire...
A 78-year-old man presented with an eight-month history of folliculocentric, pink, hyperkeratotic papules and plaques with thick white scale that involved the entire body, with confluence on the buttocks and genitalia. A biopsy specimen demonstrated superficial and focal, mild perivascular and perifollicular, band-like lymphocytic infiltrate and eosinophils. There were lymphocytes extending to the dermo-epidermal junction with vacuolar changes. A diagnosis of lichenoid drug eruption secondary to a proton-pump inhibitor was made. To the best of our knowledge, only one other case of lichenoid drug eruption secondary to a proton-pump inhibitor has been reported.
Topics: Aged; Drug Eruptions; Humans; Lichenoid Eruptions; Male; Omeprazole; Proton Pump Inhibitors
PubMed: 19891921
DOI: No ID Found