Skip to main content
SpringerLink
Log in

Drug Eruptions

  • Chapter
  • First Online:
Buka's Emergencies in Dermatology

  • 1516 Accesses

Abstract

Cutaneous reactions are the most frequently occurring adverse reactions to drugs. These reactions can range from mild (two-thirds of cases) to life-threatening (one-third of cases) in the hospital setting [1, 2]. Distinguishing a mild versus a life-threatening reaction is challenging, yet critical, in the management of drug allergies. Cutaneous manifestations are frequently the earliest signs of a systemic drug allergy and can provide information on the severity and prognosis of an allergic reaction [3]. Numerous risk factors predispose patients to severe cutaneous drug reactions, including immunosuppression (especially infection with human immunodeficiency virus) [4] or mononucleosis [5], female gender [6], number of drugs being taken, and elderly age [7].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ardern-Jones MR, Friedmann PS. Skin manifestations of drug allergy. Br J Clin Pharmacol. 2011;71(5): 672–83.

    Article  PubMed  Google Scholar 

  2. Bigby M, et al. Drug-induced cutaneous reactions. A report from the Boston Collaborative Drug Surveillance Program on 15,438 consecutive inpatients, 1975 to 1982. JAMA. 1986;256(24):3358–63.

    Article  PubMed  CAS  Google Scholar 

  3. Lubart R, et al. A novel explanation for the healing effect of the Er:YAG laser during skin rejuvenation. J Cosmet Laser Ther. 2011;13(1):33–4.

    Article  PubMed  Google Scholar 

  4. Battegay M, et al. Rash with amoxycillin-clavulanate therapy in HIV-infected patients. Lancet. 1989;2(8671): 1100.

    Article  PubMed  CAS  Google Scholar 

  5. Patel BM. Skin rash with infectious mononucleosis and ampicillin. Pediatrics. 1967;40(5):910–1.

    PubMed  CAS  Google Scholar 

  6. Naldi L, et al. Cutaneous reactions to drugs. An analysis of spontaneous reports in four Italian regions. Br J Clin Pharmacol. 1999;48(6):839–46.

    Article  PubMed  CAS  Google Scholar 

  7. Ibia EO, Schwartz RH, Wiedermann BL. Antibiotic rashes in children: a survey in a private practice setting. Arch Dermatol. 2000;136(7):849–54.

    Article  PubMed  CAS  Google Scholar 

  8. Thong BY, et al. Drug allergy in a general hospital: Results of a novel prospective inpatient reporting system. Ann Allergy Asthma Immunol. 2003;90(3): 342–7.

    Article  PubMed  Google Scholar 

  9. Bastuji-Garin S, et al. Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme. Arch Dermatol. 1993;129(1):92–6.

    Article  PubMed  CAS  Google Scholar 

  10. Chan HL, et al. The incidence of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. A population-based study with particular reference to reactions caused by drugs among outpatients. Arch Dermatol. 1990;126(1): 43–7.

    Article  PubMed  CAS  Google Scholar 

  11. Strom BL, et al. A population-based study of Stevens-Johnson syndrome. Incidence and antecedent drug exposures. Arch Dermatol. 1991;127(6):831–8.

    Article  PubMed  CAS  Google Scholar 

  12. Naldi L, et al. Incidence of toxic epidermal necrolysis in Italy. Arch Dermatol. 1990;126(8):1103–4.

    Article  PubMed  CAS  Google Scholar 

  13. Roujeau JC, et al. Toxic epidermal necrolysis (Lyell syndrome). Incidence and drug etiology in France, 1981–1985. Arch Dermatol. 1990;126(1):37–42.

    Article  PubMed  CAS  Google Scholar 

  14. Prendiville JS, et al. Management of Stevens-Johnson syndrome and toxic epidermal necrolysis in children. J Pediatr. 1989;115(6):881–7.

    Article  PubMed  CAS  Google Scholar 

  15. French LA, Prins C. Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis. In: Bologina JL, Jorizzo JL, Rapini R, editors. Urticarias, erythemas, and pupuras. 2nd ed. Philadelphia, PA: Elsevier; 2008.

    Google Scholar 

  16. Wolkenstein PE, Roujeau JC, Revuz J. Drug-induced toxic epidermal necrolysis. Clin Dermatol. 1998;16(3): 399–408.

    Article  PubMed  CAS  Google Scholar 

  17. Roujeau JC, Stern RS. Severe adverse cutaneous reactions to drugs. N Engl J Med. 1994;331(19): 1272–85.

    Article  PubMed  CAS  Google Scholar 

  18. Lee A. Drug induced skin reactions. London: Pharmaceutical Press; 2006.

    Google Scholar 

  19. Murata J, Abe R, Shimizu H. Increased soluble Fas ligand levels in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis preceding skin detachment. J Allergy Clin Immunol. 2008;122(5):992–1000.

    Article  PubMed  CAS  Google Scholar 

  20. Chung WH, et al. Granulysin is a key mediator for disseminated keratinocyte death in Stevens-Johnson syndrome and toxic epidermal necrolysis. Nat Med. 2008;14(12):1343–50.

    Article  PubMed  CAS  Google Scholar 

  21. Schopf E, et al. Toxic epidermal necrolysis and Stevens-Johnson syndrome. An epidemiologic study from West Germany. Arch Dermatol. 1991;127(6): 839–42.

    Article  PubMed  CAS  Google Scholar 

  22. Mockenhaupt M, et al. The risk of Stevens-Johnson syndrome and toxic epidermal necrolysis associated with nonsteroidal antiinflammatory drugs: a multinational perspective. J Rheumatol. 2003;30(10): 2234–40.

    PubMed  CAS  Google Scholar 

  23. Devi K, et al. Carbamazepine–the commonest cause of toxic epidermal necrolysis and Stevens-Johnson syndrome: a study of 7 years. Indian J Dermatol Venereol Leprol. 2005;71(5):325–8.

    Article  PubMed  CAS  Google Scholar 

  24. Mockenhaupt M, et al. Stevens-Johnson syndrome and toxic epidermal necrolysis: assessment of medication risks with emphasis on recently marketed drugs. The EuroSCAR-study. J Invest Dermatol. 2008;128(1):35–44.

    Article  PubMed  CAS  Google Scholar 

  25. Levi N, et al. Medications as risk factors of Stevens-Johnson syndrome and toxic epidermal necrolysis in children: a pooled analysis. Pediatrics. 2009;123(2): e297–304.

    Article  PubMed  Google Scholar 

  26. Wetter DA, Camilleri MJ. Clinical, etiologic, and histopathologic features of Stevens-Johnson syndrome during an 8-year period at Mayo Clinic. Mayo Clin Proc. 2010;85(2):131–8.

    Article  PubMed  Google Scholar 

  27. Lebargy F, et al. Pulmonary complications in toxic epidermal necrolysis: a prospective clinical study. Intensive Care Med. 1997;23(12):1237–44.

    Article  PubMed  CAS  Google Scholar 

  28. Revuz J, et al. Toxic epidermal necrolysis. Clinical findings and prognosis factors in 87 patients. Arch Dermatol. 1987;123(9):1160–5.

    Article  PubMed  CAS  Google Scholar 

  29. Wong KC, Kennedy PJ, Lee S. Clinical manifestations and outcomes in 17 cases of Stevens-Johnson syndrome and toxic epidermal necrolysis. Australas J Dermatol. 1999;40(3):131–4.

    Article  PubMed  CAS  Google Scholar 

  30. Harr T, French LE. Toxic epidermal necrolysis and Stevens-Johnson syndrome. Orphanet J Rare Dis. 2010;5:39.

    Article  PubMed  Google Scholar 

  31. Gerull R, Nelle M, Schaible T. Toxic epidermal necrolysis and Stevens-Johnson syndrome: a review. Crit Care Med. 2011;39(6):1521–32.

    Article  PubMed  Google Scholar 

  32. Bastuji-Garin S, et al. SCORTEN: a severity-of-illness score for toxic epidermal necrolysis. J Invest Dermatol. 2000;115(2):149–53.

    Article  PubMed  CAS  Google Scholar 

  33. Garcia-Doval I, et al. Toxic epidermal necrolysis and Stevens-Johnson syndrome: does early withdrawal of causative drugs decrease the risk of death? Arch Dermatol. 2000;136(3):323–7.

    Article  PubMed  CAS  Google Scholar 

  34. Oplatek A, et al. Long-term follow-up of patients treated for toxic epidermal necrolysis. J Burn Care Res. 2006;27(1):26–33.

    Article  PubMed  Google Scholar 

  35. Dunn K, Edwards-Jones V. The role of acticoat with nanocrystalline silver in the management of burns. Burns. 2004;30 Suppl 1:S1–9.

    Article  PubMed  Google Scholar 

  36. Wolf R, et al. Life-threatening acute adverse cutaneous drug reactions. Clin Dermatol. 2005;23(2): 171–81.

    Article  PubMed  Google Scholar 

  37. Brown KM, et al. Toxic epidermal necrolysis: does immunoglobulin make a difference? J Burn Care Rehabil. 2004;25(1):81–8.

    Article  PubMed  CAS  Google Scholar 

  38. Prins C, Gelfand EW, French LE. Intravenous immunoglobulin: properties, mode of action and practical use in dermatology. Acta Derm Venereol. 2007;87(3): 206–18.

    PubMed  CAS  Google Scholar 

  39. Campione E, et al. High-dose intravenous immunoglobulin for severe drug reactions: efficacy in toxic epidermal necrolysis. Acta Derm Venereol. 2003;83(6):430–2.

    PubMed  CAS  Google Scholar 

  40. Prins C, et al. Treatment of toxic epidermal necrolysis with high-dose intravenous immunoglobulins: multicenter retrospective analysis of 48 consecutive cases. Arch Dermatol. 2003;139(1):26–32.

    Article  PubMed  CAS  Google Scholar 

  41. Shortt R, et al. Intravenous immunoglobulin does not improve outcome in toxic epidermal necrolysis. J Burn Care Rehabil. 2004;25(3):246–55.

    Article  PubMed  Google Scholar 

  42. Valeyrie-Allanore L, et al. Open trial of ciclosporin treatment for Stevens-Johnson syndrome and toxic epidermal necrolysis. Br J Dermatol. 2010;163(4): 847–53.

    Article  PubMed  CAS  Google Scholar 

  43. Harr T, French LE. Severe cutaneous adverse reactions: acute generalized exanthematous pustulosis, toxic epidermal necrolysis and Stevens-Johnson syndrome. Med Clin North Am. 2010;94(4):727–42. x.

    Article  PubMed  Google Scholar 

  44. Pichler WJ, Tilch J. The lymphocyte transformation test in the diagnosis of drug hypersensitivity. Allergy. 2004;59(8):809–20.

    Article  PubMed  CAS  Google Scholar 

  45. Kano Y, et al. Utility of the lymphocyte transformation test in the diagnosis of drug sensitivity: dependence on its timing and the type of drug eruption. Allergy. 2007;62(12):1439–44.

    Article  PubMed  CAS  Google Scholar 

  46. Magina S, et al. Dermatological and ophthalmological sequels in toxic epidermal necrolysis. Dermatology. 2003;207(1):33–6.

    Article  PubMed  CAS  Google Scholar 

  47. Gueudry J, et al. Risk factors for the development of ocular complications of Stevens-Johnson syndrome and toxic epidermal necrolysis. Arch Dermatol. 2009;145(2):157–62.

    Article  PubMed  Google Scholar 

  48. Power WJ, et al. Analysis of the acute ophthalmic manifestations of the erythema multiforme/Stevens-Johnson syndrome/toxic epidermal necrolysis disease spectrum. Ophthalmology. 1995;102(11):1669–76.

    PubMed  CAS  Google Scholar 

  49. Roujeau JC, et al. Reporting adverse drug reactions. Lancet. 1985;2(8466):1244.

    Article  PubMed  CAS  Google Scholar 

  50. Westly ED, Wechsler HL. Toxic epidermal necrolysis. Granulocytic leukopenia as a prognostic indicator. Arch Dermatol. 1984;120(6):721–6.

    Article  PubMed  CAS  Google Scholar 

  51. Wolf R, et al. Drug rash with eosinophilia and systemic symptoms vs toxic epidermal necrolysis: the dilemma of classification. Clin Dermatol. 2005;23(3):311–4.

    Article  PubMed  Google Scholar 

  52. Descamps V, et al. Association of human herpesvirus 6 infection with drug reaction with eosinophilia and systemic symptoms. Arch Dermatol. 2001;137(3): 301–4.

    PubMed  CAS  Google Scholar 

  53. Fiszenson-Albala F, et al. A 6-month prospective survey of cutaneous drug reactions in a hospital setting. Br J Dermatol. 2003;149(5):1018–22.

    Article  PubMed  CAS  Google Scholar 

  54. Clark RA, et al. The vast majority of CLA  +  T cells are resident in normal skin. J Immunol. 2006;176(7): 4431–9.

    PubMed  CAS  Google Scholar 

  55. Schaerli P, et al. A skin-selective homing mechanism for human immune surveillance T cells. J Exp Med. 2004;199(9):1265–75.

    Article  PubMed  CAS  Google Scholar 

  56. Pichler WJ. Pharmacological interaction of drugs with antigen-specific immune receptors: the p-i concept. Curr Opin Allergy Clin Immunol. 2002;2(4):301–5.

    Article  PubMed  Google Scholar 

  57. Picard D, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS): a multiorgan antiviral T cell response. Sci Transl Med. 2010;2(46):46ra62.

    Article  PubMed  Google Scholar 

  58. Eshki M, et al. Twelve-year analysis of severe cases of drug reaction with eosinophilia and systemic symptoms: a cause of unpredictable multiorgan failure. Arch Dermatol. 2009;145(1):67–72.

    Article  PubMed  Google Scholar 

  59. Saida S, et al. A case of drug-induced hypersensitivity syndrome-like symptoms following HHV-6 encephalopathy. Allergol Int. 2010;59(1):83–6.

    Article  PubMed  CAS  Google Scholar 

  60. Chen YC, Chiu HC, Chu CY. Drug reaction with eosinophilia and systemic symptoms: a retrospective study of 60 cases. Arch Dermatol. 2010;146(12): 1373–9.

    Article  PubMed  Google Scholar 

  61. Gupta A, et al. Drug-induced hypothyroidism: the thyroid as a target organ in hypersensitivity reactions to anticonvulsants and sulfonamides. Clin Pharmacol Ther. 1992;51(1):56–67.

    Article  PubMed  CAS  Google Scholar 

  62. Spanou Z, et al. Involvement of drug-specific T cells in acute drug-induced interstitial nephritis. J Am Soc Nephrol. 2006;17(10):2919–27.

    Article  PubMed  CAS  Google Scholar 

  63. Chung WH, et al. Medical genetics: a marker for Stevens-Johnson syndrome. Nature. 2004;428(6982):486.

    Article  PubMed  CAS  Google Scholar 

  64. Walsh SA, Creamer D. Drug reaction with eosinophilia and systemic symptoms (DRESS): a clinical update and review of current thinking. Clin Exp Dermatol. 2011;36(1):6–11.

    Article  PubMed  CAS  Google Scholar 

  65. Mockenhaupt M. Severe drug-induced skin reactions: clinical pattern, diagnostics and therapy. J Dtsch Dermatol Ges. 2009;7(2):142–60. quiz 161-2.

    PubMed  Google Scholar 

  66. Bohan KH, Mansuri TF, Wilson NM. Anticonvulsant hypersensitivity syndrome: implications for pharmaceutical care. Pharmacotherapy. 2007;27(10): 1425–39.

    Article  PubMed  CAS  Google Scholar 

  67. Beltraminelli HS, et al. Acute generalized exanthematous pustulosis induced by the antifungal terbinafine: case report and review of the literature. Br J Dermatol. 2005;152(4):780–3.

    Article  PubMed  CAS  Google Scholar 

  68. Halevy S. Acute generalized exanthematous pustulosis. Curr Opin Allergy Clin Immunol. 2009;9(4): 322–8.

    Article  PubMed  Google Scholar 

  69. Bachot N, Roujeau JC. Differential diagnosis of severe cutaneous drug eruptions. Am J Clin Dermatol. 2003;4(8):561–72.

    Article  PubMed  Google Scholar 

  70. Roujeau JC. Clinical heterogeneity of drug hypersensitivity. Toxicology. 2005;209(2):123–9.

    Article  PubMed  CAS  Google Scholar 

  71. Sidoroff A, et al. Risk factors for acute generalized exanthematous pustulosis (AGEP)-results of a multinational case–control study (EuroSCAR). Br J Dermatol. 2007;157(5):989–96.

    Article  PubMed  CAS  Google Scholar 

  72. Pirquet SV. Serum sickness. Baltimore: Wilkins; 1951.

    Google Scholar 

  73. Lawley TJ, et al. A prospective clinical and immunologic analysis of patients with serum sickness. N Engl J Med. 1984;311(22):1407–13.

    Article  PubMed  CAS  Google Scholar 

  74. Vincent C, Revillard JP. Antibody response to horse gamma-globulin in recipients of renal allografts: relationship with transplant crises and transplant survival. Transplantation. 1977;24(2):141–7.

    Article  PubMed  CAS  Google Scholar 

  75. Clark BM, et al. Severe serum sickness reaction to oral and intramuscular penicillin. Pharmacotherapy. 2006;26(5):705–8.

    Article  PubMed  Google Scholar 

  76. Wilson CB, Dixon FJ. Quantitation of acute and chronic serum sickness in the rabbit. J Exp Med. 1971;134(3):7–18.

    PubMed  CAS  Google Scholar 

  77. King BA, Geelhoed GC. Adverse skin and joint reactions associated with oral antibiotics in children: the role of cefaclor in serum sickness-like reactions. J Paediatr Child Health. 2003;39(9):677–81.

    Article  PubMed  CAS  Google Scholar 

  78. Knowles SR, Shear NH. Recognition and management of severe cutaneous drug reactions. Dermatol Clin. 2007;25(2):245–53. viii.

    Article  PubMed  CAS  Google Scholar 

  79. Brucculeri M, Charlton M, Serur D. Serum sickness-like reaction associated with cefazolin. BMC Clin Pharmacol. 2006;6:3.

    Article  PubMed  Google Scholar 

  80. Vial T, et al. Cefaclor-associated serum sickness-like disease: eight cases and review of the literature. Ann Pharmacother. 1992;26(7–8):910–4.

    PubMed  CAS  Google Scholar 

  81. Molldrem JJ, et al. Antithymocyte globulin for patients with myelodysplastic syndrome. Br J Haematol. 1997;99(3):699–705.

    Article  PubMed  CAS  Google Scholar 

  82. Hommes DW, van Deventer SJ. Infliximab therapy in Crohn’s disease: safety issues. Neth J Med. 2003;61(4):100–4.

    PubMed  CAS  Google Scholar 

  83. D’Arcy CA, Mannik M. Serum sickness secondary to treatment with the murine-human chimeric antibody IDEC-C2B8 (rituximab). Arthritis Rheum. 2001;44(7):1717–8.

    Article  PubMed  Google Scholar 

  84. Todd DJ, Helfgott SM. Serum sickness following treatment with rituximab. J Rheumatol. 2007;34(2):430–3.

    PubMed  Google Scholar 

  85. Lundquist AL, et al. Serum sickness following rabbit antithymocyte-globulin induction in a liver transplant recipient: case report and literature review. Liver Transpl. 2007;13(5):647–50.

    Article  PubMed  Google Scholar 

  86. Bielory L, et al. Cutaneous manifestations of serum sickness in patients receiving antithymocyte globulin. J Am Acad Dermatol. 1985;13(3):411–7.

    Article  PubMed  CAS  Google Scholar 

  87. Joubert GI, et al. Selection of treatment of cefaclor-associated urticarial, serum sickness-like reactions and erythema multiforme by emergency pediatricians: lack of a uniform standard of care. Can J Clin Pharmacol. 1999;6(4):197–201.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatolgoy, Mount Sinai School of Medicine, 5 East 98th Street, 1048, New York, NY, 10029, USA

    Rita V. Patel M.D. & Gary Goldenberg M.D.

Authors
  1. Rita V. Patel M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gary Goldenberg M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gary Goldenberg M.D. .

Editor information

Editors and Affiliations

  1. , Department of Dermatology, Mount Sinai School of Medicine, Front Street 220, New York, 10038, New York, USA

    Bobby Buka

  2. , Department of Dermatology, Mount Sinai School of Medicine, Front Street 220, New York, 10038, New York, USA

    Annemarie Uliasz

  3. , Dermatology, Jacobi Medical Center, Albert Einstein College of Medicine, Pelham Parkway South, Bronx, 10461, New York, USA

    Karthik Krishnamurthy

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Patel, R.V., Goldenberg, G. (2013). Drug Eruptions. In: Buka, B., Uliasz, A., Krishnamurthy, K. (eds) Buka's Emergencies in Dermatology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5031-3_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-5031-3_3

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-5030-6

  • Online ISBN: 978-1-4614-5031-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation