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Schwere Hautreaktionen auf neue Medikamente

Severe skin reactions due to new medications

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Zusammenfassung

Stevens-Johnson-Syndrom (SJS), toxisch epidermale Nekrolyse (TEN) sowie eine spezifische Form des Hypersensitivitätssyndroms, das heute als „drug reaction with eosinophilia and systemic symptoms“ (DRESS) bezeichnet wird, zählen zu den schweren, meist arzneimittelinduzierten Hautreaktionen. Während SJS/TEN als eine Reaktionsform unterschiedlichen Schweregrades angesehen wird, muss DRESS durch eine Multiorganbeteiligung hiervon wie auch von anderen schweren Exanthemen unterschieden werden. Obwohl SJS/TEN allgemein als Arzneimittelreaktion gilt, sind insgesamt nur ca. drei Viertel der Fälle tatsächlich durch Arzneimittel ausgelöst. Nach Stellen der klinischen Diagnose gehört die Eruierung des möglichen Auslösers zu den wichtigsten Maßnahmen. Sollte es sich um medikamentöse Auslöser handeln, kommt dem Absetzen derselben eine Schlüsselrolle zu. Um das verursachende Arzneimittel identifizieren und absetzen zu können, muss eine sehr detaillierte und gründliche Medikamentenanamnese erhoben werden. Zu den Substanzen, die in pharmakoepidemiologischen Studien als Auslöser von SJS/TEN identifiziert oder bestätigt wurden, gehören Allopurinol, antibakterielle Sulfonamide, verschiedene Antiepileptika, Nevirapin sowie nichtsteroidale Antirheumatika vom Oxicam-Typ. Unter den Arzneimitteln, die DRESS induzieren, finden sich ebenfalls verschiedene Antiepileptika, aber auch Allopurinol, Sulfonamide und Minocyclin. Einzelfälle von SJS/TEN und DRESS im Zusammenhang mit der Anwendung neuer Medikamente, unter diesen auch sog. zielgerichtete Therapien und Biologika, wurden beobachtet.

Abstract

Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and a specific form of hypersensitivity syndrome which is nowadays called “drug reaction with eosinophilia and systemic symptoms” (DRESS) are severe, mainly drug-induced skin reactions. Whereas SJS/TEN is considered one reaction entity of different severity, DRESS has to be distinguished from SJS/TEN but also from other severe exanthems due to multiorgan involvement. Although SJS/TEN is generally referred to as drug reaction, in total only about three quarters of the cases are actually caused by drugs. After the clinical diagnosis is made, identification of the potential inducing factor is most important. In case medications are considered as causal, their withdrawal plays a key role in management. In order to identify and withdraw the inducing agent, a detailed and thorough medication history must be obtained. Agents identified or confirmed as inducers of SJS/TEN by pharmacoepidemiological studies are allopurinol, antibacterial sulfonamides, various antiepileptics, nevirapine and nonsteroidal anti-inflammatory drugs of the oxicam-type. Among drugs inducing DRESS are also various antiepileptics, but in addition allopurinol, sulfonamides and minocycline. Some cases of SJS/TEN and DRESS associated with the use of new medication, including targeted therapies and biologicals, have been observed.

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  1. Dokumentationszentrum schwerer Hautreaktionen (dZh), Universitätsklinik für Dermatologie und Venerologie, Hauptstr. 7, 79104, Freiburg, Deutschland

    M. Mockenhaupt & M. Paulmann

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M. Mockenhaupt und M. Paulmann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor.

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Mockenhaupt, M., Paulmann, M. Schwere Hautreaktionen auf neue Medikamente. Hautarzt 69, 278–289 (2018). https://doi.org/10.1007/s00105-018-4153-2

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