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Drug Reactions

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Hospital-Based Dermatopathology

Abstract

Drug reactions are among the most commonly encountered skin disorders in hospitalized patients. Although most drug reactions are not life-threatening, some reactions represent the primary indication for hospital admission and can be associated with severe disability or death. With rare exception, histopathologic features alone are not specifically diagnostic of a drug reaction. Yet, a significant proportion of hospitalized patients with skin reactions undergo skin biopsy, since histopathologic features may facilitate definitive confirmation of, support for, or exclusion of disorders in the clinical differential diagnosis. From the standpoint of clinical relevance, the perceived diagnostic specificity of histopathologic features may hinge critically on the disorders comprising the clinical differential diagnosis and the clinical presentation. While it is appropriate to reflexively search for eosinophils to support a drug reaction, no single histologic feature is specific. In fact, the reality is that drug reactions can mimic essentially any pattern of inflammatory skin disease, a single drug can cause multiple reaction patterns, and many drugs can produce an identical histologic appearance. Thus, drug reactions may be appropriately suspected but not unequivocally confirmed by histology alone. The following review summarizes clinical and histologic features of the major forms of drug reactions with emphasis on the full spectrum of documented histopathologic features in clinically confirmed cases.

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Authors and Affiliations

  1. Clinical Dermatology and Pathology, Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA

    Maxwell A. Fung

  2. Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA

    Danielle M. Tartar & Alain Brassard

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  1. Maxwell A. Fung
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  2. Danielle M. Tartar
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  3. Alain Brassard
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Correspondence to Maxwell A. Fung .

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Editors and Affiliations

  1. Professor of Pathology, Harvard Medical School, Director of Dermatopathology, Massachusetts General Hospital, Boston, MA, USA

    Mai P. Hoang

  2. Professor of Pathology and Dermatology, Director, Dermatopathology Unit, Duke University Medical Center, Durham, NC, USA

    Maria Angelica Selim

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Fung, M.A., Tartar, D.M., Brassard, A. (2020). Drug Reactions. In: Hoang, M., Selim, M. (eds) Hospital-Based Dermatopathology. Springer, Cham. https://doi.org/10.1007/978-3-030-35820-4_15

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