drug induced exfoliative dermatitis

Clin Mol Allergy 14, 9 (2016). 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. Cookies policy. A population-based study of StevensJohnson syndrome. Loss of normal vasoconstrictive function in the dermis, decreased sensitivity to the shivering reflex and extra cooling that comes from evaporation of the fluids leaking out of the weeping skin lesions all result in thermoregulatory dysfunction that can cause hypothermia or hyperthermia.6 The basal metabolic rate also is increased in patients with exfoliative dermatitis. Int J Dermatol. Anticoagulation therapy. Harr T, French LE. Kreft B, et al. 2012;53(3):16571. Kano Y, et al. Antiepileptic medications, antihypertensive medications, antibiotics, calcium channel blockers and a variety of topical agents (Table 2)2,3,69 can cause exfoliative dermatitis, but theoretically, any drug may cause exfoliative dermatitis. ALDEN has shown a good accuracy to assess drug causality compared to data obtained by pharmacovigilance method and casecontrol results of the EuroSCAR casecontrol analysis for drugs associated with TEN. In acute phase it is crucial to assess the culprit agent, in particular when the patient was assuming several drugs at time of DHR. [81]. Immunol Allergy Clin North Am. J Allergy Clin Immunol. Skin manifestations of drug allergy. Clin Exp Dermatol. Medication use and the risk of StevensJohnson syndrome or toxic epidermal necrolysis. Even though there is not a significant increase in the number of T cells infiltrating the skin of TEN patients, it was found that their role is crucial, even more than HLAs types. Bickle K, Roark TR, Hsu S. Autoimmune bullous dermatoses: a review. Exfoliative dermatitis has been reported in association with hepatitis, acquired immunodeficiency syndrome, congenital immunodeficiency syndrome (Omenn's syndrome) and graft-versus-host disease.2,1517, In reviews of erythroderma, a significant percentage of patients (about 25 percent) do not receive a specific etiologic diagnosis. 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 . 1996;44(2):1646. Rzany B, et al. If there is a high suspicion of infection without a documented source of infection, broad range empiric therapy should be started. Epilepsia. Combination of infliximab and high-dose intravenous immunoglobulin for toxic epidermal necrolysis: successful treatment of an elderly patient. Open trial of ciclosporin treatment for StevensJohnson syndrome and toxic epidermal necrolysis. 2015;13(7):62545. PubMed Central Lymphocyte transformation test (LTT) performed as described by Pichler and Tilch [77] shows a lower sensitivity in severe DHR compared to less severe DHR [78] but, if available, should be performed within 1week after the onset of skin rash in SJS and TEN [79]. Su SC, Hung SI, Fan WL, Dao RL, Chung WH. Because a certain degree of cross-reactivity between the various aromatic anti-epileptic drugs exists, some HLAs have been found to be related to SJS/TEN with two drugs, as the case of HLA-B*1502 with both phenytoin and oxcarbazepine [32]. 2012;97:14966. and transmitted securely. Allergy. 2000;115(2):14953. Etoricoxib-induced toxic epidermal necrolysis: successful treatment with infliximab. Provided by the Springer Nature SharedIt content-sharing initiative. Theoretically, any drug may cause exfoliative dermatitis. Lonjou C, et al. In any case all authors concluded that the blockage of FasL prevents keratinocyte apoptosis [35]. A case of anti-BP230 antibody-positive dyshidrosiform bullous pemphigoid secondary to dipeptidyl peptidase-4 inhibitor in a 65-year-old Filipino female 2012;43:10115. A systematic review of treatment of drug-induced StevensJohnson syndrome and toxic epidermal necrolysis in children. HLA-A* 3101 and carbamazepine-induced hypersensitivity reactions in Europeans. See this image and copyright information in PMC. Schwartz RA, McDonough PH, Lee BW. Jarrett P, et al. This is particularly true for patients with many comorbidities and poli-drug therapy, where it is advisable to monitor liver and kidney toxicity and to avoid Vitamin A excess [99]. Skin and appendages: acne, bruising, erythema multiforme, exfoliative dermatitis, pruritus ani, rash, skin ulceration, Stevens . Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T. Clin Rev Allergy Immunol. Common acute symptoms include abdominal pain or cramps, nausea, vomiting, and diarrhea, jaundice, skin rash and eyes dryness and therefore could mimic the prodromal and early phase of ED. Copyright 1999 by the American Academy of Family Physicians. N Engl J Med. What are Drug Rashes? Verma R, Vasudevan B, Pragasam V. Severe cutaneous adverse drug reactions. Chung and colleagues found an high expression of this molecule in TEN blister fluid [39] and confirmed both in vitro and in vivo its dose-dependent cytotoxicity [39]. Toxic epidermal necrolysis (Lyell syndrome). 1 PubMed Central 1996;35(4):2346. Huff JC, Weston WL, Tonnesen MG. Erythema multiforme: a critical review of characteristics, diagnostic criteria, and causes. Chung W-H, et al. [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). Topical treatment. Hypothermia can result in ventricular flutter, decreased heart rate and hypotension. In patients who develop complications (i.e., infection, fluid and electrolyte abnormalities, cardiac failure), the rate of mortality is often high. 2014;71(1):1956. Springer Nature. Drugs such as paracetamol, other non-oxicam NSAIDs and furosemide, bringing a relatively low risk of SJS/TEN a priori, are also highly prevalent as putative culprit agents in large SJS/TEN registries, due to their widespread use in the general population [63, 64] (Table1). In order to rule out autoimmune blistering diseases, direct immune fluorescence staining should be additionally performed to exclude the presence of immunoglobulin and/or complement deposition in the epidermis and/or the epidermal-dermal zone, absent in ED. Erythema multiforme (photo reproduced with, Erythema multiforme (photo reproduced with permission of Gary White, MD): typical target lesions, Mortality rate of patients with TEN has shown to be directly correlated to, Management of patients with a suspected drug induced exfoliative dermatitis, MeSH Fritsch PO. As written before, Sassolas B. et al. Main discriminating factors between EMM, SJS, SJS-TEN, TEN and SSSS is summarized in Table3 [84]. The authors declare that they have no competing interests. In more severe cases corneal protective lens can be used. Hospitalization and dermatologic consultation are indicated in most cases to ensure that all of the necessary cutaneous, laboratory and radiologic investigations and monitoring are performed. 2010;2(3):18994. Also a vesical catheter should be placed to avoid urethral synechiae and to have a precise fluid balance. Most common used drugs are: morphine, fentanyl, propofol and midazolam. J Dermatol Sci. Liver injury and exfoliative dermatitis caused by nifuratel[J]. In contrast with DRESS, eosinophilia and atypical lymphocytes are not described in patients with SJS or TEN. Next vol/issue Histopathological and epidemiological characteristics of patients with erythema exudativum multiforme major, StevensJohnson syndrome and toxic epidermal necrolysis. A slow acetylator genotype is a risk factor for sulphonamide-induced toxic epidermal necrolysis and StevensJohnson syndrome. Check the full list of possible causes and conditions now! Growth-factors (G-CSF). 2010;88(1):608. 2013;69(2):173174. Acute and chronic leukemia may also cause exfoliative dermatitis. In spared areas it is necessary to avoid skin detachment. 2015;21:13343. By using this website, you agree to our 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). Annu Rev Pharmacol Toxicol. To confirm ATT induced erythroderma and narrow down the offending agents, sequential rechallenge with ATT was done and again these patients had similar lesions erupt all over the body only with isoniazid and pyrazinamide. Chemicals and Drugs 61. These highlights do not include all the information needed to use Exfoliative dermatitis is a rare inflammatory skin condition that is characterized by desquamation and erythema involving more than 90% of the body surface area. In EMM their efficacyis demonstrated in controlling the evolution of the disease [106]. Interferon alfa (Roferon-A, Intron A, Alferon N), Isoniazid (Laniazid, Nydrazid; also in Rifamate, Rimactane), Isosorbide dinitrate (Isordil, Sorbitrate), Para-amino salicylic acid (Sodium P.A.S. Painkiller therapy. In particular, a specific T cell clonotype was present in the majority of patients with carbamazepine-induced SJS/TEN and that this clonotype was absent in all patients tolerant to the drug who shared the same HLA with the SJS/TEN patients [45]. Pfizer Receives Positive FDA Advisory Committee Votes Supporting In some studies, the nose and paranasal area are spared. J Am Acad Dermatol. No uniformity of opinion exists concerning the best treatment for cutaneous T-cell lymphoma. Bookshelf Nayak S, Acharjya B. Recurrent erythema multiforme in association with recurrent Mycoplasma pneumoniae infections. erythroderma, exfoliative dermatitis, and fixed drug reactions) 4, 5 and . HLA-B1502, HLA-B5701, HLA-B5801 and carbamazepine, abacavir, and allopurinol, respectively). Medicines have been linked to every type of rash, ranging from mild to life-threatening. When it precedes cutaneous T-cell lymphoma lesions, exfoliative dermatitis becomes the presenting sign of the underlying malignancy. Targeting keratinocyte apoptosis in the treatment of atopic dermatitis and allergic contact dermatitis. Archivio Istituzionale della Ricerca Unimi, Nayak S, Acharjya B. 2014;70(3):53948. Acute processes usually favor large scales, whereas chronic processes produce smaller ones. Applications of Immunopharmacogenomics: Predicting, Preventing, and Understanding Immune-Mediated Adverse Drug Reactions. The most notable member of this group is mycosis fungoides. Ann Intern Med. Among the anti-tubercular drugs exfoliative dermatitis is reported with rifampicin, isoniazid, ethambutol, pyrazinamide, streptomycin, PAS either singly or in combination of two drugs in some cases. Medication-Induced Erythroderma | SpringerLink Drug induced exfoliative dermatitis: state of the art. - Abstract Fritsch PO. The EuroSCAR-study. 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. The management of toxic epidermal necrolysis. J Am Acad Dermatol. AB, CC, ET, GAR, AN, EDL, PF performed a critical revision on the current literature about the described topic, wrote and revised the manuscript. StevensJohnson syndrome and toxic epidermal necrolysis: assessment of medication risks with emphasis on recently marketed drugs. CD94/NKG2C is a killer effector molecule in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. Talk to our Chatbot to narrow down your search. Although the final result of this dual interaction is still under investigation, it seems that the combination of TNF-, IFN- (also present in TEN patients) and the activation of other death receptors such as TWEAK can lead to apoptosis of keratinocytes [44]. The prognosis of cases associated with malignancy typically depends on the outcome of the underlying malignancy. Erythroderma in adults - UpToDate ), Phenolphthalein (Agoral, Alophen, Modane), Rifampin (Rifadin, Rimactane; also in Rifamate), Trimethoprim (Trimpex; also in Bactrim, Septra). Ther Apher Dial. Here we provide a systematic review on frequency, risk factors, pathogenesis, clinical features and management of patients with drug induced ED. Immunophenotypic studies with the use of advanced antibody panels may be useful in the differential diagnosis of these two forms.10 Reticulum cell sarcoma is another form of cutaneous T-cell lymphoma that may cause exfoliative dermatitis. Please enable it to take advantage of the complete set of features! The authors concluded for a potential beneficial effect of Cys A and a possible improvement in survival compared to IVIG. Unlike EMM, SJS and TEN are mainly related to medication use. J Immunol. Kaffenberger BH, Rosenbach M. Toxic epidermal necrolysis and early transfer to a regional burn unit: is it time to reevaluate what we teach? TEN is characterized by full-thickness epidermal necrosis with an evident epidermal detachment and sloughing caused by necrosis of keratinocytes following apoptosis [49, 52]. . Hospitalization is usually necessary for initial evaluation and treatment. Download Free PDF. Toxic epidermal necrolysis: Part II Prognosis, sequelae, diagnosis, differential diagnosis, prevention, and treatment. Br J Dermatol. Dermatol Clin. For the calculation, available values on vital and laboratory parameters within the first 3days after admission to the first hospital are considered when the reaction started outside the hospital (community patients) or at the date of hospitalization for in-hospital patients. 2018 Jan 28;2018:9095275. doi: 10.1155/2018/9095275. 2003 Oct 25;147(43):2089-94. Patients with underlying skin disorders may respond much more slowly to therapy, but clearing almost always occurs eventually. doi: 10.1111/dth.15416. 2012;66(6):e22936. PubMed Med J Armed Forces India. 2015;49(3):33542. Moreover Mawson A and colleagues hypothesized that the efficacy of plasmapheresis is able to reduce serum level of vitamin A. In a hemodialysis patient with active pulmonary tuberculosis, early withdrawl followed by prompt rechallenging to identify the causative agent and then to achieve cure of pulmonary tuberculosis is an interesting therapeutic challenge. 2008;128(1):3544. Effects of treatments on the mortality of StevensJohnson syndrome and toxic epidermal necrolysis: a retrospective study on patients included in the prospective EuroSCAR Study. Erythema multiforme (EM), StevensJohnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. f. Ethambutol Induced Exfoliative Dermatitis. Erythema multiforme and toxic epidermal necrolysis: a comparative study. Skin testing and patch testing in non-IgE-mediated drug allergy. Robyn A. McMenamin, L M. Davies and P. W. Craswell, Aust. Article -. It is also extremely important to obtain within the first 24h cultural samples from skin together with blood, urine, nasal, pharyngeal and bronchus cultures. official website and that any information you provide is encrypted Severe Cutaneous Adverse Reactions: The Pharmacogenomics from Research to Clinical Implementation. Usually, but not always, the palms of the hands, the soles of the feet and the mucous membranes are spared. Privacy 2012;27(4):21520. Cite this article. New York: McGraw-Hill; 2003. p. 54357. It was used with success in different case reports [114116]. Bourgeois GP, et al. Palynziq PEGVALIASE 20 mg/mL BioMarin Pharmaceutical Inc. It should be considered only once the patient is stable and if the skin damage is still ongoing and doesnt respond to other conventional therapies (corticosteroids or IVIG).

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