drug induced exfoliative dermatitis11 Apr drug induced exfoliative dermatitis
Garza A, Waldman AJ, Mamel J. 2014;71(5):9417. Dent Clin North Am. Samim F, et al. Yamada H, Takamori K. Status of plasmapheresis for the treatment of toxic epidermal necrolysis in Japan. Adapted from Ref. Wolkenstein P, et al. Rabelink NM, Brakman M, Maartense E, Bril H, Bakker-Wensveen CA, Bavinck JN. 22 Abacavir-induced hypersensitivity syndrome is strongly associated with HLA-B*5701 during treatment . 2012;53(3):16571. Moreover, the time necessary for cells to mature and travel through the epidermis is decreased. In case of a respiratory failure, oxygen should be administrated and a NIMV may be required. 2008;34(1):636. In: Eisen AZ, Wolff K, editors. In case of an oral mucositis that impairs nutrition, it is indicated to position a nasogastric tube. Polak ME, et al. 2004;59(8):80920. Considered variables in SCORTEN are shown in Table2. Fritsch PO. Contact Dermatitis. Allergy. Incidence and antecedent drug exposures. J Popul Ther Clin Pharmacol. Chang CC, et al. Many people have had success using a dilute vinegar bath rather than a bleach bath. Cyclosporine A (Cys A): Cys A works through the inhibition of calcineurin, that is fundamental for cytotoxic T lymphocytes activation. Nutr Clin Pract. Defective regulatory T cells in patients with severe drug eruptions: timing of the dysfunction is associated with the pathological phenotype and outcome. 2008;52(3):1519. Hypersensitivity, Delayed Drug Hypersensitivity Radiodermatitis Drug Eruptions Skin Diseases Hypersensitivity Hand-Foot Syndrome Hypersensitivity, Immediate Dermatitis, Contact Erythema Foot Dermatoses Hand Dermatoses Skin Neoplasms Dermatitis, Allergic Contact Alveolitis, Extrinsic Allergic Acneiform Eruptions Dentin Sensitivity Dermatitis Int J Dermatol. Theoretically, any drug may cause exfoliative dermatitis. First of all, Sassolas and coauthors proposed an algorithm of drug causality (ALDEN) in order to improve the individual assessment of drug causality in TEN and SJS [71]. If it is exfoliative dermatitis that's drug induced, it's easy to treat . Mona-Rita Yacoub. The incidence of erythema multiforme, StevensJohnson syndrome, and toxic epidermal necrolysis. HHS Vulnerability Disclosure, Help Here we provide a systematic review on frequency, risk factors, pathogenesis, clinical features and management of patients with drug induced ED. J Am Acad Dermatol. J Invest Dermatol. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. For SJS/TEN, corticosteroids are the cornerstone of treatment albeit efficacy remains unclear. The timing of the rash can also vary. Bourgeois GP, et al. [16] Drug-induced Liver Disease Study Group,Chinese Society of Hepatology,Chinese Medical Association. The efficacy of intravenous immunoglobulin for the treatment of toxic epidermal necrolysis: a systematic review and meta-analysis. Diclofenac sodium topical solution, like other NSAIDs, can cause serious systemic skin side effects such as exfoliative dermatitis, SJS, and TEN, which may result in hospitalizations . 2012;27(4):21520. Australas J Dermatol. These patches tend to spread until, after a matter of days or weeks, most of the skin surface is covered with an erythematous, pruritic eruption. 2013;27(3):35664. 1990;126(1):3742. Hydration and hemodynamic balance. 2009;182(12):80719. 2011;38(3):23645. PubMed The scales may be small or large, superficial or deep. 2013;168(3):53949. The exact source of FasL production has not been yet identified as different groups have postulated that the production might be sought in keratinocytes themselves [33] or in peripheral blood mononuclear cells [34]. Drug eruptions that initially present as morbilliform, lichenoid or urticarial rashes may progress to generalized exfoliative dermatitis. Wu PA, Cowen EW. The incidence of cutaneous adverse drug reactions (CADRs) is high in HIV-infected persons; however, there are large gaps in knowledge about several aspects of HIV-associated CADRs in Africa, which carries the biggest burden of the disease. PubMed 2012;167(2):42432. Abstract Acute interstitial nephritis associated with hepatitis, exfoliative dermatitis, fever and eosinophilia is uncommon. [49] confirmed these results and even suggested that higher dosage regimen with 2.74g/kg seem to be more effective in survival outcome. 2010;85(2):131138. Pemphigus vulgaris usually starts in the oral mucosa followed by blistering of the skin, which is often painful. J Am Acad Dermatol. Br J Dermatol. Applications of Immunopharmacogenomics: Predicting, Preventing, and Understanding Immune-Mediated Adverse Drug Reactions. Clinicians using antivirals for mpox should be alert for drug-drug interactions with any antiretrovirals used to prevent 16, 17 or treat 18 HIV infection as well as with any other medications used to prevent or treat HIV-related opportunistic infections. Advise of potential risk to a fetus and use of effective contraception. J Invest Dermatol. A serious cutaneous adverse drug reaction namely exfoliative dermatitis (erythroderma) is associated with isoniazid use . 1996;44(2):1646. Szary syndrome, the leukemic variant of mycosis fungoides, is also associated with exfoliative dermatitis. Bullous dermatoses can be debilitating and possibly fatal. Recurrence occurs in around one-third of cases [15] and there is a genetic predisposition for certain Asian groups [16]. 1). official website and that any information you provide is encrypted New York: McGraw-Hill; 2003. pp. 19 Key critical interactions are discussed below for each mpox antiviral. 2022 May;35(5):e15416. For carbamazpine, several studies have found a common link between specific HLAs and different kinds of cutaneous adverse reactions, as for HLA-A*3101 in Japanese [30] and Europeans [31]. Partial to full thickness epidermal necrosis, intraepidermal vesiculation or subepidermal blisters, due to spongiosis and to the cellular damage of the basal layer of the epidermis, can be present in the advanced disease [49] Occasionally, severe papillary edema is also present [20]. Fritsch PO. Despite improved knowledge of the immunopathogenesis of these conditions, immune-modulatory therapies currently used have not been definitively proved to be efficacious [49, 107], and new strategies are urgently needed. Patients must be cleaned in the affected areas until epithelization starts. Int J Dermatol. . 2002;65(9):186170. Avoid rubbing and scratching. In contrast with DRESS, eosinophilia and atypical lymphocytes are not described in patients with SJS or TEN. Annu Rev Pharmacol Toxicol. McCormack M, et al. Case Rep Dermatol. Acute processes usually favor large scales, whereas chronic processes produce smaller ones. Diagnosis in a routine setting is based on patch test (PT) while skin test (prick and intradermal tests) with a delayed reading are contraindicated in these patients [72]. Do this 2 to 3 times a week. Frequently reported adverse events of rebamipide compared to other drugs for peptic ulcer and gastroesophageal reflux disease. It is not completely clear whether EM and SJS are separate clinical entities or if they represent two different expressions of a single disease process. Br J Dermatol. Drug-Induced Kidney Injury & Exfoliative Dermatitis Symptom Checker: Possible causes include Gold Salt. Mawson AR, Eriator I, Karre S. StevensJohnson syndrome and toxic epidermal necrolysis (SJS/TEN): could retinoids play a causative role? 2013;69(2):173174. [80], which consists of the determination of IFN and IL4 by ELISpot (Enzyme-linked immunospot assay), allowing to increase the sensitivity of LTT during acute DHR (82 versus 50% if compared to LPA). Acute generalized exanthematous pustulosis (AGEP) is characterized by acute erythematous skin lesions, generally arising in the face and intertriginous areas, subsequently sterile pinhead-sized nonfollicular pustules arise and if they coalesce, may sometimes mimic a positive Nikolskys sign and in this case the condition may be misinterpreted as TEN [86]. . Volume 8, Issue 1 Pages 1-90 (August 1994). [71] realized an algorhitm named ALDEN (algorithm of drug causality for epidermal necrolysis) which helps to establish a cause/effect relationship as probable or very probable in 70% of cases. Google Scholar. Continue Reading. SJS/TEN syndrome is associated with severe blistering, mucocutaneous peeling, and multi-organ damage and could be life threatening. 1998;282(5388):4903. Pathophysiology DIP. Pharmacogenet Genom. Morel E, et al. Arch Dermatol. These studies have confirmed an association between carbamazepine-induced SJS/TEN with HLA-B*1502 allele among Han Chinese [27], carbamazepine and HLA-A*3101 and HLA-B*1511 [16], phenytoin and HLA-B*1502 [28], allopurinol and HLA-B*5801 [29]. 2012;2012:915314. MRY, MGS, EN and GC designed the study, selected scientifically relevant information, wrote and revised the manuscript. In recent years, clinicians have come to believe that this condition is secondary to a complicated interaction of cytokines and cellular adhesion molecules. Khalil I, et al. Google Scholar. Patients should be educated to avoid any causative drugs. A case of toxic epidermal necrolysis with involvement of the GI tract after systemic contrast agent application at cardiac catheterization. Patmanidis K, et al. Mardani M, Mardani S, Asadi Kani Z, Hakamifard A. Dermatol Ther. J Invest Dermatol. PMC Ganciclovir and cidofovir should be used when polymerase-chain reactions (PCR) on peripheral blood or other biological sample identifies a viral reactivation (HHV6, HHV7, EBV and CMV). Google Scholar. f. In EM a lymphocytic infiltrate (CD8+ and macrophages), associated with vacuolar changes and dyskeratosis of basal keratinocytes, is found along the dermo-epidermal junction, while there is a moderate lymphocytic infiltrate around the superficial vascular plexus [20]. Sekula P, et al. J Dermatol. StevensJohnson syndrome and toxic epidermal necrolysis. In the hospital, special attention must be given to maintaining temperature control, replacing lost fluids and electrolytes, and preventing and treating infection. 2013;27(5):65961. EMM is characterizes by target lesions, circular lesions of 1-2cm of diameter, that are defined as typical or atypical that tends to blister. Takahashi R, et al. 12 out of 17 studies concluded for a positive role of IVIG in ED. Drug induced exfoliative dermatitis (ED) are a group of rare and severe drug hypersensitivity reactions (DHR) involving skin and usually occurring from days to several weeks after drug exposure. Recent advances in the genetics and immunology of StevensJohnson syndrome and toxic epidermal necrosis. Huang YC, Li YC, Chen TJ. Previous vol/issue. Lonjou C, et al. New York: McGraw-Hill; 2003. pp. It could also be useful to use artificial tears and lubricating antiseptic gels. They found that the inhibition of these molecules could attenuate the cytotoxic effect of lymphocytes toward keratinocytes. Medical genetics: a marker for StevensJohnson syndrome. Interleukin (IL)-1, IL-2, IL-8, intercellular adhesion molecule 1 (ICAM-1), tumor necrosis factor and interferon gamma are the cytokines that may have roles in the pathogenensis of exfoliative dermatitis.2. Ann Allergy Asthma Immunol. Hung S-I, et al. Abe J, et al. The most commonly used steroids were methylprednisolone, prednisolone and dexamethasone. Archivio Istituzionale della Ricerca Unimi, Nayak S, Acharjya B. The SJS histology is characterized by a poor dermal inflammatory cell infiltrate and full thickness necrosis of epidermis [20, 49]. Chung WH, et al. [113] retrospectively compared mortality in 64 patients with ED treated either with iv or oral Cys A (35mg/kg) or IVIG (25g/Kg). 2012;43:10115. The lymphocyte transformation test in the diagnosis of drug hypersensitivity. Google Scholar. The velocity of infusion should be regulated according to patients arterial pressure with the aim of 30mL/h urinary output (1mL/kg/h in case of a child). In EMM their efficacyis demonstrated in controlling the evolution of the disease [106]. Article Painkiller therapy. 2001;108(5):83946. Role of nanocrystalline silver dressings in the management of toxic epidermal necrolysis (TEN) and TEN/StevensJohnson syndrome overlap. Autologous transplantation of mesenchymal umbilical cord cells seems also to be highly efficacious [102]. Sequelae of exfoliative dermatitis are not widely reported. Moreover Mawson A and colleagues hypothesized that the efficacy of plasmapheresis is able to reduce serum level of vitamin A. In the acute phase, before determination of the etiology, treatment consists of measures to soothe the inflamed skin. In postmarketing reports, cases of drug-induced hepatotoxicity have been reported in the first month, and in some cases, the first 2 months of NSAID therapy. ADRJ,2015,17(6):464-465. Generalized exfoliative dermatitis, or erythroderma, is a severe inflammation of the entire skin surface. 2012;66(6):9951003. Skin testing in delayed reactions to drugs. 2013;168(3):55562. oboda J, Dudzik A, Chomyszyn-Gajewska M. Ramirez GA, Ripa M, Burastero S, Benanti G, Bagnasco D, Nannipieri S, Monardo R, Ponta G, Asperti C, Cilona MB, Castagna A, Dagna L, Yacoub MR. Microorganisms. Pregnancy . It is also extremely important to obtain within the first 24h cultural samples from skin together with blood, urine, nasal, pharyngeal and bronchus cultures. Keywords: By using this website, you agree to our 2012;51(8):889902. 2010 Oct;35(7):723-8. doi: 10.1111/j.1365-2230.2009.03718.x. 2005;94(4):41923. Four cases are described, two of which were due to phenindione sensitivity. The average age at onset is 55 years, although exfoliative dermatitis may occur at any time.2, Exfoliative dermatitis is the result of a dramatic increase in the epidermal turnover rate. In most severe cases the suggested dosage is iv 11.5mg/kg/day. 2015;56(4):298302. California Privacy Statement, Orton PW, et al. Napoli B, et al. Intravenous administration is recommended. 2015;49(3):33542. 1999;48(5):21726. Clinical features; Delayed type hypersensitivity; Drug hypersensitivity; Erythema multiforme; Exfoliative dermatitis; Lyells syndrome; Pathogenesis; StevensJohnson syndrome; Therapy; Toxic epidermal necrolysis. Open trial of ciclosporin treatment for StevensJohnson syndrome and toxic epidermal necrolysis. Google Scholar. Exfoliative dermatitis is characterized by generalized erythema with scaling or desquamation affecting at least 90% of the body surface area. A recently published meta-analysis by Huang [110] and coworkers on IVIG in SJS/SJS-TEN/TEN reviewed 17 studies with 221 patients and compared the results obtained with high-dosage IVIG (>2g/kg) compared to lower-dosage IVIG (<2g/kg). Grieb G, et al. Anticoagulation therapy. tion in models of the types of systemic disease for S. aureus pathogenesis research is also expected to receive which anti-virulence drugs would be most desirable. New York: McGraw-Hill; 2003. p. 54357. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2014;71(1):1956. Immunoregulatory effector cells in drug-induced toxic epidermal necrolysis. Typical laboratory values include mild anemia, leukocytosis, eosinophilia, elevated erythrocyte sedimentation rate, abnormal serum protein electrophoresis with a polyclonal elevation in the gamma globulin region, and elevated IgE levels.13,68. 2014;81(1):1521. An extremely rare mucocutaneous adverse reaction following COVID-19 vaccination: Toxic epidermal necrolysis. Gen Dent. Part of N Engl J Med. 2016;2:14. Oral manifestations of erythema multiforme. . 2010;5:39. Paradisi A, et al. Increased peripheral blood flow can result in high-output cardiac failure. J Burn Care Res. Epub 2022 Mar 9. Wetter DA, Camilleri MJ. Both hyperthermia and hypothermia are reported. Kirchhof MG et al. government site. It is necessary to obtain as soon as possible a central venous access and to start a continuous monitoring of vital signs. exfoliative dermatitis. Targeting keratinocyte apoptosis in the treatment of atopic dermatitis and allergic contact dermatitis. Paul C, et al. CAS Erythema multiforme and toxic epidermal necrolysis: a comparative study. Talk to our Chatbot to narrow down your search. Accurate eye cleaning with saline solution is fundamental for the prevention of synechiae and for reducing corneal damage. The most common of these are psoriasis, atopic dermatitis, seborrheic dermatitis, contact dermatitis and pityriasis rubra pilaris. Four main pathways have been found to play important roles in the pathogenesis of keratinocyte death: (1) Fas-FasL interaction, (2) Perforin/granzyme B pathway, (3) Granulysin and (4) Tumor necrosis factor (TNF-) [26]. 2018 Jan 28;2018:9095275. doi: 10.1155/2018/9095275. Roujeau JC, et al. J Dtsch Dermatol Ges. N Engl J Med. Half-life of the drug is approximately 54 h. Modification of nitisinone in liver and renal dysfunction is yet to be studied. Chan HL, et al. During the acute reaction, diagnosis of ED is mainly based on clinical parameters. 5% silver nitrate compresses have antiseptic properties. 2003;21(1):195205. Given the different histopathological features of the EM, SJS and TEN, we decided to discuss them separately. Other patients may warrant PUVA (psoralen plus ultraviolet A) phototherapy, systemic steroids (if psoriasis has been ruled out), retinoids (for exfoliative dermatitis secondary to psoriasis and pityriasis rubra pilaris), or immunosuppressive agents such as methotrexate (Rheumatrex) and azathioprine (Imuran).2527, When used as adjunctive therapy, behavior modification designed to eliminate persistent scratching has been successful in reducing the rate of excoriation and increasing the rate of healing.28. J Allergy Clin Immunol. Article Genotyping is recommended in specific high-risk ethnic groups (e.g. Erythroderma is an intense and widespread reddening of the skin due to inflammation which may often be associated with peeling of skin termed as exfoliative dermatitis. doi: 10.4103/0019-5154.39732. Ann Pharmacother. Allergol Immunopathol (Madr). N.Z. Risk factors for the development of ocular complications of StevensJohnson syndrome and toxic epidermal necrolysis. Patch testing in severe cutaneous adverse drug reactions, including StevensJohnson syndrome and toxic epidermal necrolysis. Article Am J Dermatopathol. J Am Acad Dermatol. Disclaimer. J Dermatol. Pehr K. The EuroSCAR study: cannot agree with the conclusions. Del Pozzo-Magana BR, et al. Curr Probl Dermatol. A catabolic state thus ensues, which is often responsible for significant weight loss. 2008;159(4):9814. Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Br J Dermatol. Drug reactions are one of the most common causes of exfoliative dermatitis. 2019 Jan 6;59:463-486. doi: 10.1146/annurev-pharmtox-010818-021818. Harr T, French LE. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Focus on the Pathophysiological and Diagnostic Role of Viruses. Immune-histopathological features allow to distinguish generalized bullous drug eruption from SJS/TEN [36].
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