drug induced exfoliative dermatitis drug induced exfoliative dermatitis

doi: 10.4103/0019-5154.39732. 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. Article In acute phase it is crucial to assess the culprit agent, in particular when the patient was assuming several drugs at time of DHR. 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. Stevens-Johnson syndrome and toxic epidermal necrolysis due to anticonvulsants share certain clinical and laboratory features with drug-induced hypersensitivity syndrome, despite differences in cutaneous presentations. Google Scholar. J. It can lead to pain, appear on large parts of the body and may require hospitalization. Etoricoxib-induced toxic epidermal necrolysis: successful treatment with infliximab. HHS Vulnerability Disclosure, Help 2012;66(6):e22936. Abstract Acute interstitial nephritis associated with hepatitis, exfoliative dermatitis, fever and eosinophilia is uncommon. Affiliated tissues include skin, liver and bone marrow. Smith SD, et al. EMM is characterizes by target lesions, circular lesions of 1-2cm of diameter, that are defined as typical or atypical that tends to blister. Cookies policy. 1997;22(3):1467. Previous vol/issue. Epilepsia. 2010;37(10):9046. Br J Dermatol. 8600 Rockville Pike Students also viewed Nostra aetate - Summary Theology: the basics Principles of Risk Management and Insurance Chapters 1-4 Frequently reported adverse events of rebamipide compared to other drugs for peptic ulcer and gastroesophageal reflux disease. These levels could reflect the interaction between culprit drugs and aldehyde dehydrogenase that is the enzyme which metabolizes retinoid acid. Erythroderma See more images of erythroderma. Minerva Stomatol. More than moderate, unresponsive to treatment, and which interferes with the Soldier's perfor-mance of duty. Apoptosis-inducing factors and lymphocyte-mediated cytotoxicity have been deeply investigated in ED. Bastuji-Garin S, et al. 2013;27(5):65961. 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]. The exact role of FasL in the pathogenesis of toxic epidermal necrolysis is still questionable especially because a correlation between serum FasL levels and disease severity has not been established and because its levels have been found to be increased also in drug-induced hypersensitivity syndrome and maculopapular eruption [36]. The most important actions to do are listed in Fig. Br J Dermatol. In serious cases invasive ventilation can be necessary for ARDS. 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. 1997;19(2):12732. 2012;167(2):42432. 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. Toxic epidermal necrolysis: review of pathogenesis and management. Erythroderma (literally, "red skin"), also sometimes called exfoliative dermatitis, is a severe and potentially life-threatening condition that presents with diffuse erythema and scaling involving all or most of the skin surface area (90 percent, in the most common definition). 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. Albumin is recommended only is albumin serum level is <2.5mg/dL. Temporary tracheostomy may be necessary in case of extended mucosal damage. 2009;182(12):80719. 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]. Overall, T cells are the central player of these immune-mediated drug reactions. Exfoliative dermatitis is also a risk factor for epidemic spread of methicillin-resistant Staphylococcus aureus.6,20. 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]. This compressed maturation process results in an overall greater loss of epidermal material, which is manifested clinically as severe scaling and shedding. 2012;43:10115. For SJS/TEN, corticosteroids are the cornerstone of treatment albeit efficacy remains unclear. 2018 Jan 28;2018:9095275. doi: 10.1155/2018/9095275. Hum Mol Genet. Barbaud A, et al. Khalil I, et al. Erythema multiforme to amoxicillin with concurrent infection by Epstein-Barr virus. The scales may be small or large, superficial or deep. 1996;135(2):3056. 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. A systematic review of treatment of drug-induced StevensJohnson syndrome and toxic epidermal necrolysis in children. ADRJ,2015,17(6):464-465. 2013;69(2):173174. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). In HIV patients, the risk of SJS and TEN have been reported to be thousand-fold higher, roughly 1 per 1000 per year [19]. Most common used drugs are: morphine, fentanyl, propofol and midazolam. 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. . Robyn A. McMenamin, L M. Davies and P. W. Craswell, Aust. McCormack M, et al. 5% silver nitrate compresses have antiseptic properties. 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]. 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]. Iv bolus of steroid (dexamethasone 100300mg/day or methylprednisolone 2501000mg/day) for 3 consecutive days with a gradual taper steroid therapy is sometimes advised. 1996;35(4):2346. Nutr Clin Pract. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Amphotericin B injection and potassium-depleting agents: When corticosteroids are administered concomitantly with potassium-depleting agents (ie, amphotericin B, diuretics), patients should be observed closely for development of hypokalemia.There have been cases reported in which concomitant . 2015;56(4):298302. In most severe cases the suggested dosage is iv 11.5mg/kg/day. Supportive and specific care includes both local and systemic measures, as represented in Fig. Mockenhaupt M, et al. J Allergy Clin Immunol. Fitzpatricks dermatology in general medicine. 2011;38(3):23645. Roujeau JC, et al. 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. Kaffenberger BH, Rosenbach M. Toxic epidermal necrolysis and early transfer to a regional burn unit: is it time to reevaluate what we teach? Heat loss is another major concern that accompanies a defective skin barrier in patients with exfoliative dermatitis. In case of an oral mucositis that impairs nutrition, it is indicated to position a nasogastric tube. Poor relevance of a lymphocyte proliferation assay in lamotrigine-induced StevensJohnson syndrome or toxic epidermal necrolysis. Article [113] retrospectively compared mortality in 64 patients with ED treated either with iv or oral Cys A (35mg/kg) or IVIG (25g/Kg). Gastric protection. statement and Blood counts and bone marrow studies may reveal an underlying leukemia. d. Cysts and tumors. Unauthorized use of these marks is strictly prohibited. The erythrodermic form of mycosis fungoides and the Szary syndrome may also be difficult to distinguish from benign erythroderma. of Internal Medicine, University of Bari, Bari, Italy, Andrea Nico,Elisabetta Di Leo,Paola Fantini&Eustachio Nettis, You can also search for this author in Ozeki T, et al. 2010;125(3):70310. Main discriminating factors between EMM, SJS, SJS-TEN, TEN and SSSS is summarized in Table3 [84]. 1998;37(7):5203. 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. Am J Dermatopathol. 2015;64(3):2779. GULIZ KARAKAYLI, M.D., GRANT BECKHAM, M.D., IDA ORENGO, M.D., AND TED ROSEN, M.D. Paulmann M, Mockenhaupt M. Severe drug-induced skin reactions: clinical features, diagnosis, etiology, and therapy. Patients can be extremely suffering because of the pain induced by skin and mucosal detachment. Growth-factors (G-CSF). Important data on ED have been obtained by RegiSCAR (European Registry of Severe Cutaneous Adverse Reactions to Drugs: www.regiscar.org), an ongoing pharmaco-epidemiologic study conducted in patients with SJS and TEN. DRUG- Induced- Dermatologic-RXNS lam University St. John's University Course Drug induced disease (CPP 6102) Academic year2023/2024 Helpful? The authors concluded that they couldnt demonstrate corticosteroids efficacy in monotherapy, but the use of steroid alone is not linked to an increased risk of mortality due to infective complications [108, 109]. 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. Pathophysiology DIP. Hung S-I, et al. Correction of hyperthermia or hypothermia Antibiotic administration when underlying infection is suspected or identified as cause of exfoliative dermatitis or when a secondary skin and soft. Fritsch PO. https://doi.org/10.1186/s12948-016-0045-0, DOI: https://doi.org/10.1186/s12948-016-0045-0. Toxic epidermal necrolysis and StevensJohnson syndrome. This site needs JavaScript to work properly. 2014;71(5):9417. 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]. Locharernkul C, et al. 2012;97:14966. Fritsch PO. The .gov means its official. 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. Harr T, French LE. AB, CC, ET, GAR, AN, EDL, PF performed a critical revision on the current literature about the described topic, wrote and revised the manuscript. Paquet P, et al. Arch Dermatol. J Am Acad Dermatol. All non-indispensable drugs have to be stopped because they could alter the metabolism of the culprit agent. Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Apoptosis as a mechanism of keratinocyte death in toxic epidermal necrolysis. 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]. In: Eisen AZ, Wolff K, editors. Trautmann A, et al. Int J Dermatol. CAS Ardern-Jones MR, Friedmann PS. The most common causes of exfoliative dermatitis are best remembered by the mnemonic device ID-SCALP. Furosemide or ethacrynic acid may be required to maintain an adequate urinary output [90]. 2002;146(4):7079. In the 5 studies that concluded negatively for IVIG, the dosage was below 0.4g/kg/day and treatment was maintained for less than 5days. Ann Intern Med. 2011;20(2):10712. It recommended to used G-CSF in patients with febrile neutropenia [94, 95]. Exp Dermatol. 2002;109(1):15561. Rheumatology (Oxford). Harr T, French LE. 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 Jang E, Park M, Jeong JE, Lee JY, Kim MG. Sci Rep. 2022 May 12;12(1):7839. doi: 10.1038/s41598-022-11505-0. 2005;62(4):63842. J Allergy Clin Immunol. Rzany B, et al. Fitzpatricks dermatology in general medicine. Four cases are described, two of which were due to phenindione sensitivity. Ann Burns Fire. It is also recommended to void larger vesicles with a syringe. Since cutaneous function as a multiprotective barrier is so disrupted in exfoliative dermatitis, the body loses heat, water, protein and electrolytes, and renders itself much more vulnerable to infection. The prognosis of cases associated with malignancy typically depends on the outcome of the underlying malignancy. . 2008;14(12):134350. The team should include not only physicians but also dedicated nurses, physiotherapists and psychologists and should be instituted during the first 24h after patient admission. Descamps V, Ranger-Rogez S. DRESS syndrome. Von Hebra first described erythroderma (exfoliative dermatitis) in 1868. A serious cutaneous adverse drug reaction namely exfoliative dermatitis (erythroderma) is associated with isoniazid use . Wetter DA, Camilleri MJ. The balance of fluids and electrolytes should be closely monitored, since dehydration or hypervolemia can be problems. Umbilical cord mesenchymal stem cell transplantation in drug-induced StevensJohnson syndrome. Systemic corticosteroids: These are the most common used drugs because of their known anti-inflammatory and immunosuppressive effect through the inhibition of activated cytotoxic T-cells and the production of cytokines. Clinical, etiologic, and histopathologic features of StevensJohnson syndrome during an 8-year period at Mayo Clinic. Erythema multiforme and toxic epidermal necrolysis. Exposure to anticonvulsivants (phenytoin, phenobarbital, lamotrigine), non-nucleoside reverse transcriptase inhibitors (nevirapine), cotrimoxazole and other sulfa drugs (sulfasalazine), allopurinol and oxicam NSAIDs [2] confers a higher risk of developing SJS/TEN. Wetter DA, Davis MD. 2012;66(6):9951003. Allergol Immunopathol (Madr). Man CB, et al. The dermis shows an inflammatory infiltrate characterized by a high-density lichenoid infiltrate rich in T cells (CD4+ more than CD8+) with macrophages, few neutrophils and occasional eosinophils; the latter especially seen in cases of DHR [5, 50]. Antipyretic therapy. Ther Apher Dial. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. . Viard I, et al. An extremely rare mucocutaneous adverse reaction following COVID-19 vaccination: Toxic epidermal necrolysis. 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]. In an open trial on cyclosporine in 29 patients with TEN, the use of Cys A for at least 10days led to a rapid improvement without infective complications [112]. Erythroderma is the term used to describe intense and usually widespread reddening of the skin due to inflammatory skin disease. c. Amyloidosis. Br J Dermatol. 2019 Jan 6;59:463-486. doi: 10.1146/annurev-pharmtox-010818-021818. A pseudolymphoma reaction with fever, arthralgias, lymphadenopathy, hepatosplenomegaly, anemia and erythroderma may develop as a result of hypersensitivity to dapsone or antiepileptic drugs. Combination of infliximab and high-dose intravenous immunoglobulin for toxic epidermal necrolysis: successful treatment of an elderly patient. 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]. 2011;18:e12133. doi: 10.1016/j.jaad.2013.05.003. Med., 1976, 6, pp. Br J Dermatol. loss of taste Derm: stevens-johnson syndrome, toxic epidermal necrolysis, rash, exfoliative dermatitis, hair . asiatic) before starting therapies with possible triggers (e.g. Roujeau JC, et al. 1991;97(4):697700. Genome-wide association study identifies HLA-A* 3101 allele as a genetic risk factor for carbamazepine-induced cutaneous adverse drug reactions in Japanese population. It is a clinical manifestation and usually associated with various underlying cutaneous disorders, drug induced reactions and malignancies. J Am Acad Dermatol. Antibiotic therapy. Toxic epidermal necrolysis associated with severe cytomegalovirus infection in a patient on regular hemodialysis. Trigger is an exotoxin released by Staphylococcus aureus [83]. Both DRESS and SJS may have increased liver enzymes and hepatitis, but they occur in only 10% of cases of SJS compared to 80% of DRESS. Recurrent erythema multiforme: clinical characteristics, etiologic associations, and treatment in a series of 48 patients at Mayo Clinic, 2000 to 2007. [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. Erythema multiforme and latent herpes simplex infection. Dermatologist and/or allergist should confirm the diagnosis, individuate the culprit agent, give indications about skin management and necessity to obtain theconsultationofthe ENT specialist, the gynecologist/urologist, the ophthalmologist and/or the pulmonologist in the case of mucosal involvement. 1). See this image and copyright information in PMC. View ABRIGO_Worksheet #8 Drug Study_Endocrine System.pdf from NCM 06 at Southern Luzon State University (multiple campuses). Since the earliest descriptions of exfoliative dermatitis, medications have been known to be important causative agents. Clin Exp Dermatol. Chem Immunol Allergy. It was used with success in different case reports [114116]. Allergol Int. Infliximab: chimeric IgG monoclonal anti-TNF- antibody. Death ligand TRAIL, secreted by CD1a+and CD14+cells in blister fluids, is involved in killing keratinocytes in toxic epidermal necrolysis. Ibuprofen Zentiva can be prescribed with OTC Recipe - self-medication. PubMed Central Basal-cell carcinoma; Other names: Basal-cell skin cancer, basalioma: An ulcerated basal cell carcinoma near the ear of a 75-year-old male: Specialty [Erythema multiforme vs. Stevens-Johnson syndrome and toxic epidermal necrolysis: an important diagnostic distinction].