drug induced exfoliative dermatitis

Wolkenstein P, et al. oboda J, Dudzik A, Chomyszyn-Gajewska M. Ramirez GA, Ripa M, Burastero S, Benanti G, Bagnasco D, Nannipieri S, Monardo R, Ponta G, Asperti C, Cilona MB, Castagna A, Dagna L, Yacoub MR. Microorganisms. Moreover, the time necessary for cells to mature and travel through the epidermis is decreased. CAS Systemic and potentially life-threatening complications include fluid and electrolyte imbalance, thermoregulatory disturbance, fever, tachycardia, high-output failure, hypoalbuminemia, and septicemia. A recently published meta-analysis by Huang [110] and coworkers on IVIG in SJS/SJS-TEN/TEN reviewed 17 studies with 221 patients and compared the results obtained with high-dosage IVIG (>2g/kg) compared to lower-dosage IVIG (<2g/kg). Bastuji-Garin S, et al. SCORTEN: a severity-of-illness score for toxic epidermal necrolysis. Patients present an acute high-grade of skin and mucosal insufficiency that obviously leads to great impairment in the defenses against bacteria that normally live on the skin, increasing the high risk of systemic infections. The .gov means its official. The SJS histology is characterized by a poor dermal inflammatory cell infiltrate and full thickness necrosis of epidermis [20, 49]. 2014;70(3):53948. 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. Fitzpatricks dermatology in general medicine. Mayes T, et al. (2.4, 5.6) Embryo-fetal Toxicity: Can cause fetal harm. 2013;52(1):3444. Blood counts and bone marrow studies may reveal an underlying leukemia. . In patients with this disorder, the mitotic rate and the absolute number of germinative skin cells are higher than normal. When less than 10% of the body surface area (BSA) is involved, it is defined SJS, when between 10 and 30% of BSA it is defined overlapping SJS/TEN, when more than 30% of BSA, TEN [2] (Additional file 1: Figure S1, Additional file 2: Figure S2). The relative risk of leukemia inducing erythroderma is highly variable, ranging from 11 to 50 percent.11, Internal (visceral) malignancies cause about 1 percent of all cases of exfoliative dermatitis.11 Frequently, erythroderma is the presenting sign of the malignancy. [Stevens-Johnson Syndrom and Toxic Epidermal Necrolysis--based on literature]. 2000;22(5):4137. 2012;66(3):1906. SJS and TEN are two overlapping syndromes resembling severe burn lesions and characterized by skin detachment. Hematologic: anemia, including aplastic and hemolytic. 2013;69(2):173174. Blood gas analysis, glucose and creatinine levels together with electrolytes should be evaluated and therapy should be modified accordingly. It could also be useful to use artificial tears and lubricating antiseptic gels. N Engl J Med. Kavitha Saravu. Ther Apher Dial. 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]. Pichler WJ, Tilch J. N Engl J Med. Recombinant granulocyte colony-stimulating factor in the management of toxic epidermal necrolysis. Management of patients with a suspected drug induced exfoliative dermatitis, acute generalized exanthematous pustulosis, algorithm of drug causality for epidermal necrolysis, European registry of severe cutaneous adverse reactions to drugs. Toxic epidermal necrolysis: Part I Introduction, history, classification, clinical features, systemic manifestations, etiology, and immunopathogenesis. 2011;71(5):67283. CAS Jarrett P, et al. Patch testing in severe cutaneous adverse drug reactions, including StevensJohnson syndrome and toxic epidermal necrolysis. J Dermatol Sci. In EMM lesions typically begin on the extremities and sometimes spread to the trunk. 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). 2008;34(1):636. Mediterr J Hematol Infect Dis. 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]. Case Rep Dermatol Med. Pehr K. The EuroSCAR study: cannot agree with the conclusions. Cutaneous drug eruptions are one of the most common types of adverse reaction to medications, with an overall incidence of 23% in hospitalized patients [1]. AB, CC, ET, GAR, AN, EDL, PF performed a critical revision on the current literature about the described topic, wrote and revised the manuscript. Overall, T cells are the central player of these immune-mediated drug reactions. Patient must be placed in an antidecubitus fluidized bed and room temperature must be kept at 3032C in order to slow catabolism and reduce the loss of calories through the skin [89]. Indian J Dermatol. Therefore, it is important to identify and treat any underlying disease whenever possible and to remove any contributing external factors.2, Most published studies of exfoliative dermatitis have been retrospective and thus do not address the issue of overall incidence. Springer Nature. Article 1995;333(24):16007. Bullous FDE. Immunoregulatory effector cells in drug-induced toxic epidermal necrolysis. J Am Acad Dermatol. Drug eruptions that initially present as morbilliform, lichenoid or urticarial rashes may progress to generalized exfoliative dermatitis. Disasters. 2008;49(12):208791. Patients can be extremely suffering because of the pain induced by skin and mucosal detachment. Indian J Dermatol. On the other hand, it has been demonstrated that genetic predisposition may increase the risk for sulphonamide-induced [24] and carbamazepine-induced TEN and SJS [25]. 2023 BioMed Central Ltd unless otherwise stated. 2012;166(2):32230. This has been called the nose sign.18, Once the erythema is well established, scaling inevitably follows (Figure 1). Google Scholar. 2008;23(5):54750. New York: McGraw-Hill; 2003. p. 54357. Huff JC, Weston WL, Tonnesen MG. Erythema multiforme: a critical review of characteristics, diagnostic criteria, and causes. Heat loss is another major concern that accompanies a defective skin barrier in patients with exfoliative dermatitis. Wetter DA, Camilleri MJ. Kano Y, et al. Clinical features; Delayed type hypersensitivity; Drug hypersensitivity; Erythema multiforme; Exfoliative dermatitis; Lyells syndrome; Pathogenesis; StevensJohnson syndrome; Therapy; Toxic epidermal necrolysis. The applications of topical cyclosporine and autologous serum have also been showed to be useful in refractory cases [103]. 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. Copyright 1999 by the American Academy of Family Physicians. Article Download. 2012;12(4):37682. A drug eruption may start as a rash but eventually progress to more generalized exfoliative dermatitis. Interleukin (IL)-1, IL-2, IL-8, intercellular adhesion molecule 1 (ICAM-1), tumor necrosis factor and interferon gamma are the cytokines that may have roles in the pathogenensis of exfoliative dermatitis.2. 1991;97(4):697700. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Disclaimer. 00 Comments Please sign inor registerto post comments. 2010;163(4):84753. Gonzalez-Delgado P, et al. 2008;53(1):28. StevensJohnson syndrome and toxic epidermal necrolysis: a review of the literature. 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. Arch Dermatol. Huang YC, Li YC, Chen TJ. Many people have had success using a dilute vinegar bath rather than a bleach bath. More than moderate, unresponsive to treatment, and which interferes with the Soldier's perfor-mance of duty. 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. 2007;62(12):143944. 2013;133(5):1197204. Viard I, et al. 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. 2003 Oct 25;147(43):2089-94. Barbaud A. Analysis for circulating Szary cells may be helpful, but only if the cells are identified in unequivocally large numbers. It is also recommended to void larger vesicles with a syringe. c. Amyloidosis. Its also characterized by a cell-poor infiltrate, where macrophages and dendrocytes with a strong TNF- immunoreactivity predominate [6, 50]. Annu Rev Pharmacol Toxicol. Inhibition of toxic epidermal necrolysis by blockade of CD95 with human intravenous immunoglobulin. Allergy. Retrospective review of StevensJohnson syndrome/toxic epidermal necrolysis treatment comparing intravenous immunoglobulin with cyclosporine. Von Hebra first described erythroderma (exfoliative dermatitis) in 1868. 2010 Oct;35(7):723-8. doi: 10.1111/j.1365-2230.2009.03718.x. . 543557. Dent Clin North Am. Add 1 cup (about 236 milliliters) of vinegar to a bathtub filled with warm water. 2014;71(1):1956. Br J Dermatol. d. Cysts and tumors. Paradisi A, et al. They usually have fever, are dyspneic and cannot physiologically feed. 1983;8(6):76375. 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. The fluid of blisters from TEN patients was found to be rich in TNF-, produced by monocytes/macrophages present in the epidermis [42], especially the subpopulation expressing CD16, known to produce higher levels of inflammatory cytokines [43]. Before Curr Probl Dermatol. It is recommended to use 1.5mg/kg hydrocortisone. Google Scholar. Severe adverse cutaneous reactions to drugs. Bethesda, MD 20894, Web Policies Umbilical cord mesenchymal stem cell transplantation in drug-induced StevensJohnson syndrome. An extremely rare mucocutaneous adverse reaction following COVID-19 vaccination: Toxic epidermal necrolysis. J Invest Dermatol. Epub 2018 Aug 22. 2008;159(4):9814. Stern RS. Khalaf D, et al. Tang YH, et al. 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]. Arch Dermatol. FDA Drug information Palynziq Read time: 10 mins Marketing start date: 04 Mar 2023 . Google Scholar. Exfoliative dermatitis is also a risk factor for epidemic spread of methicillin-resistant Staphylococcus aureus.6,20. 2013;27(5):65961. It is important to protect the damaged skin with sterile fat dressing especially in the genital area. Toxic epidermal necrolysis treated with cyclosporin and granulocyte colony stimulating factor. [3] The causes and their frequencies are as follows: Idiopathic - 30% Drug allergy - 28% Seborrheic dermatitis - 2% Contact dermatitis - 3% Atopic dermatitis - 10% Lymphoma and leukemia - 14% Psoriasis - 8% Treatment [ edit] 2012;13(1):4954. Int J Dermatol. Pharmacogenomics J. Int J Mol Sci. Antibiotic therapy. Still, treatment indication, choice and dosage remain unclear, and efficacy yet unproven. Erythema multiforme: a review of epidemiology, pathogenesis, clinical features, and treatment. This hypermetabolic state is also furtherly increased by the inflammation present in affected areas. Fluid balance is a main focus. A correlation between increased levels of perforin/granzyme B and the severity of TEN was also described [38]. In postmarketing reports, cases of drug-induced hepatotoxicity have been reported in the first month, and in some cases, the first 2 months of NSAID therapy. In more severe cases antiviral therapies should be given together with intravenous immunoglobulins [93]. -. Sokumbi O, Wetter DA. . Read this article to find out all its symptoms, causes and treatments. 2022 May;35(5):e15416. A multicentre study to determine the value and safety of drug patch tests for the three main classes of severe cutaneous adverse drug reactions. Provided by the Springer Nature SharedIt content-sharing initiative. Clinical clues of a drug-induced etiology include: Abrupt onset, previous morbilliform eruption, multiple, varied cutaneous morphologic lesions present together Extensive erythema is followed in 2-6 days by exfoliative scaling Pruritus can be severe, leading to scratching and lichenification in more chronic processes 2009;182(12):80719. 2002;109(1):15561. HLA-B* 5801 allele as a genetic marker for severe cutaneous adverse reactions caused by allopurinol. volume14, Articlenumber:9 (2016) Pharmacogenet Genom. 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. Talk to our Chatbot to narrow down your search. 1997;22(3):1467. Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Utility of the lymphocyte transformation test in the diagnosis of drug sensitivity: dependence on its timing and the type of drug eruption. Ned Tijdschr Geneeskd. Bullous dermatoses can be debilitating and possibly fatal. Roujeau JC, et al. 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). Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. EDs are serious and potentially fatal conditions. Nature. In conclusion, therapy wth IVIG should be started within the first 5days and an high-dosage regimen should be preferred (2.54g/kg for adults and 0.251.5g/kg in children divided in 35days). Arch Dermatol. Ann Burns Fire. Theoretically, any drug may cause exfoliative dermatitis. Case Report Here we provide a systematic review of frequency, risk factors, molecular and cellular mechanisms of reactions, clinical features, diagnostic work-up and therapy approaches to drug induced ED. Neoplastic conditions (renal and gastric carcinoma), autoimmune disease (inflammatory bowel disease), HIV infection, radiation, and food additives/chemicals have been reported to be predisposing factor [59]. Hydration and hemodynamic balance. Case Rep Dermatol. Khalil I, et al. Part of Autologous transplantation of mesenchymal umbilical cord cells seems also to be highly efficacious [102]. An epidemiologic study from West Germany. 2023 Jan 30;11(2):346. doi: 10.3390/microorganisms11020346. Semin Dermatol. Other cases are ultimately classifiable as another dermatosis. Malignancies are a major cause of exfoliative dermatitis. Contact dermatitis from topical antihistamine . Roujeau JC, Stern RS. Therefore, the clinician should always consider drugs as a possible cause. 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 Sequelae of exfoliative dermatitis are not widely reported. Allergol Immunopathol (Madr). Erythroderma is a rare but severe Adverse Drug Reaction (ADR) of phenytoin. The most common of these are psoriasis, atopic dermatitis, seborrheic dermatitis, contact dermatitis and pityriasis rubra pilaris. Recurrent erythema multiforme in association with recurrent Mycoplasma pneumoniae infections. All non-indispensable drugs have to be stopped because they could alter the metabolism of the culprit agent. Drugs that have been implicated in the causation of LPP include captopril, cinnarizine, ramipril, simvastatin, PUVA, and antituberculous medications. Guidelines for the management of drug-induced liver injury[J]. Albumin is recommended only is albumin serum level is <2.5mg/dL. 2010;37(10):9046. J Invest Dermatol. Nassif A, et al. For SJS/TEN, corticosteroids are the cornerstone of treatment albeit efficacy remains unclear. Anticoagulation therapy. Exfoliative dermatitis is a disease process in which most, and sometimes all, of the skin is involved in erythematous inflammation resulting in massive scaling.1 A variety of diseases and other exogenous factors may cause exfoliative dermatitis. 1). 2012;51(8):889902. Minerva Stomatol. 2009;151(7):5145. doi: 10.4103/0019-5154.39732. Scientific evidences suggest a role for HLAs and drug-induced SJS/TEN, although some racial differences have been found that can be due to variation of frequencies of these alleles and to the presence of other susceptibility genes [26]. Generalized exfoliative dermatitis, or erythroderma, is a severe inflammation of the entire skin surface. Detection of a herpes simplex viral antigen in skin lesions of erythema multiforme. It is important to take into consideration the mechanism of action of the different drugs in the pathogenesis of ED [104]. A marked increase in serum soluble Fas ligand in drug-induced hypersensitivity syndrome. 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]. Patients should be educated to avoid any causative drugs. 2012;97:14966. 2010;31(1):1004. eCollection 2018. The therapeutic approach of EMM, SJS, TEN depends on extension of skin, mucosal involvement and systemic patients conditions. Consultation with an oncologist who is well-versed in treatment of cutaneous T-cell lymphoma is advisable once the disease progresses to the tumor stage. Once established the percentage of the involved skin, lactate Ringer infusion of 12mL/Kg/% of involved skin must be started during the first 24h [91]. Fournier S, et al. The overall mortality rate is roughly 30%, ranging from 10% for SJS to more than 30% for TEN, with the survival rate worsening until 1year after disease onset [9, 1821]. Adverse cutaneous drug reaction. StevensJohnson syndrome and toxic epidermal necrolysis: assessment of medication risks with emphasis on recently marketed drugs. Temporary tracheostomy may be necessary in case of extended mucosal damage. Clinical, etiologic, and histopathologic features of StevensJohnson syndrome during an 8-year period at Mayo Clinic. Epub 2022 Mar 9. Recurrence occurs in around one-third of cases [15] and there is a genetic predisposition for certain Asian groups [16]. N.Z. Am Fam Physician. Exp Dermatol. 1996;44(2):1646. Genotyping is recommended in specific high-risk ethnic groups (e.g. Iv bolus of steroid (dexamethasone 100300mg/day or methylprednisolone 2501000mg/day) for 3 consecutive days with a gradual taper steroid therapy is sometimes advised. statement and Patients who have exfoliative dermatitis of unknown cause tend to have an unpredictable course, usually replete with multiple remissions and exacerbations.4. Other dermatoses associated with erythroderma are listed in Table 1.2,3,68. Cutaneous graft-versus-host diseaseclinical considerations and management. Mayo Clin Proc. The most common causes of death in patients with exfoliative dermatitis are pneumonia, septicemia and heart failure. In this study, 965 patients were reviewed. Barbaud A. Kirchhof MG, et al. A central role in the pathogenesis of ED is played by CD8+ lymphocytes and NK cells. 1992;11(3):20710. Fernando SL. Fritsch PO. It should be used only in case of a documented positivity of cultural samples. 1991;127(6):83942. Infliximab: chimeric IgG monoclonal anti-TNF- antibody. Wu PA, Cowen EW. Erythema multiforme and toxic epidermal necrolysis. Synthetic bilaminar membranes with silver nitrate have also a role in skin repairing and avoid protein loss through the damaged skin [100, 101]. The authors declare that they have no competing interests. Morel E, et al. Hence, the apparent increase in cases of exfoliative dermatitis may be related to the introduction of many new drugs. More recently, carcinomas of the fallopian tube,12 larynx13 and esophagus14 have been reported as causes of exfoliative dermatitis. 2006;6(4):2658. Cite this article. Copyright 2023 American Academy of Family Physicians. The clinical course of patients with malignancies depends on the type of malignancy and the response to appropriate therapy. Drug-induced exfoliative dermatitis is usually short-lived once the inciting medication is withdrawn and appropriate therapy is administered. Chemicals and Drugs 61. Drug-induced hypersensitivity syndrome (DiHS) or drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug-induced reaction characterized by various symptoms: skin rash, fever, lymph node enlargement and internal organ involvement, which starts within 2 weeks to 3 months after drug initiation. Trigger is an exotoxin released by Staphylococcus aureus [83]. A catabolic state thus ensues, which is often responsible for significant weight loss. Volume 8, Issue 1 Pages 1-90 (August 1994). Fitzpatricks dermatology in general medicine. J Pharm Health Care Sci. Clipboard, Search History, and several other advanced features are temporarily unavailable. Clin Exp Dermatol. Harr T, French LE. Dermatologic disorders occasionally present as exfoliative dermatitis. It often precedes or is associated with exfoliation (skin peeling off in scales or layers), when it may also be known as exfoliative dermatitis (ED). In conclusion we suggest that therapy with cyclosporine is valuable option with a dosage of 35mg/kg oral or iv for 7days. Genome-scale investigation of drug-induced termination codon-readthrough in a model system of epidermolysis bullosa . CAS Bullous pemphigoid is characterized by large, tense bullae, but may begin as an urticarial eruption. Valeyrie-Allanore L, et al. Google Scholar. California Privacy Statement, Br J Dermatol. 2012;27(4):21520. Clinical and Molecular Allergy -, Schwartz RA, McDonough PH, Lee BW. Br J Clin Pharmacol. Ozeki T, et al. It is a clinical manifestation and usually associated with various underlying cutaneous disorders, drug induced reactions and malignancies. 1984;101(1):4850. Posadas SJ, et al. . Pregnancy . All Rights Reserved. . Toxic epidermal necrolysis associated with severe cytomegalovirus infection in a patient on regular hemodialysis. See permissionsforcopyrightquestions and/or permission requests. Mucosal involvement could achieve almost 65% of patients [17]. Med Sci Monit. Toxic epidermal necrolysis: review of pathogenesis and management. The dermo-epidermal junction and epidermis are infiltrated mostly by CD8+ T lymphocytes whereas dermal infiltrate, mainly made from CD4+ T lymphocytes, is superficial and mostly perivascular [20, 51]. The exfoliative process also may involve the scalp, with 25 percent of patients developing alopecia.4 Nails can often become dystrophic, particularly in patients with preexisting psoriasis.4,6, The most frequently noted symptoms in patients with exfoliative dermatitis include malaise, pruritis and a chilly sensation. Article Apoptosis as a mechanism of keratinocyte death in toxic epidermal necrolysis. Am J Dermatopathol. Rheumatology (Oxford). The drug level peaks after 1- 4 h in plasma after ingestion with 95% protein binding. The average age at onset is 55 years, although exfoliative dermatitis may occur at any time.2, Exfoliative dermatitis is the result of a dramatic increase in the epidermal turnover rate. Topical treatment. HHS Vulnerability Disclosure, Help 2013;69(4):37583. It was used with success in different case reports [114116]. 2015;64(3):2779. Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T. Clin Rev Allergy Immunol. Robyn A. McMenamin, L M. Davies and P. W. Craswell, Aust. 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. 1991;127(6):8318. . Erythema multiforme (EM), StevensJohnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. 5% silver nitrate compresses have antiseptic properties. While nearly any medication can, in theory, cause a reaction if you're sensitive, medications linked to exfoliative dermatitis include: sulfa drugs; penicillin and certain other antibiotics . 2005;136(3):20516. Int J Dermatol. The strength of association with the development of SJS/TEN may vary among countries and historical periods, reflecting differences in ethnicities and prescription habits among the studied populations [6164]. Patients with carcinoma of the colon, lung, prostate and thyroid have presented with erythroderma. J Am Acad Dermatol. doi: 10.1016/j.jaad.2013.05.003. StevensJohnson syndrome and toxic epidermal necrolysis: the Food and Drug Administration adverse event reporting system, 2004-2013. Pemphigus vulgaris usually starts in the oral mucosa followed by blistering of the skin, which is often painful. A promising and complementary in vitro tool has been used by Polak ME et al. Here we provide a systematic review on frequency, risk factors, pathogenesis, clinical features and management of patients with drug induced ED. Garza A, Waldman AJ, Mamel J. Rzany B, et al. Bickle K, Roark TR, Hsu S. Autoimmune bullous dermatoses: a review. 2004;59(8):80920. PubMed Combination of infliximab and high-dose intravenous immunoglobulin for toxic epidermal necrolysis: successful treatment of an elderly patient. Grosber M, et al. [Erythema multiforme vs. Stevens-Johnson syndrome and toxic epidermal necrolysis: an important diagnostic distinction]. Takahashi R, et al. Kirchhof MG et al. Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. . Br J Dermatol. . First of all, Sassolas and coauthors proposed an algorithm of drug causality (ALDEN) in order to improve the individual assessment of drug causality in TEN and SJS [71]. Erythema multiforme (photo reproduced with permission of Gary White, MD): typical target lesions (white arrows) together with atypical two-zoned lesions (black arrows). Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. De Araujo E, et al. Exfoliative dermatitis accounts for about 1 percent of all hospital admissions for dermatologic conditions.3, Although the disease affects both men and women, it is more common in men, with an average male-to-female ratio of 2.3:1. Overall, incidence of SJS/TEN ranges from 2 to 7 cases per million person per year [9, 1820], with SJS the commonest [21]. If there is a high suspicion of infection without a documented source of infection, broad range empiric therapy should be started. 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. 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 Some anti-seizure medicines have also been known to cause exfoliative dermatitis. Yamada H, Takamori K. Status of plasmapheresis for the treatment of toxic epidermal necrolysis in Japan. 2013;27(3):35664. In any case all authors concluded that the blockage of FasL prevents keratinocyte apoptosis [35]. Clinical practice. Int J Dermatol. Beneficial effect of plasma exchange in the treatment of toxic epidermal necrolysis: a series of four cases.

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