Drug-induced exanthems
Introduction
Cutaneous reactions are among the most frequently observed adverse drug reactions. Most of these drug-induced exanthems can be described as erythematous or maculo-papular in nature (Bigby, 2001). However, drug allergies are known to be great imitators of diseases and can further encompass different clinical patterns like urticaria/angioedema, lichenoid or pustular skin eruptions, fixed drug eruptions, photosensitive reactions, vesicular bullous reactions, erythema exsudativum multiforme as well as rather severe reactions like Stevens-Johnson syndrome or toxic epidermal necrolysis. Although the precise underlying pathomechanisms of many of these drug eruptions remain unknown, recent studies have improved our understanding how certain drugs may elicit distinct reactions like maculo-papular, bullous or pustular eruptions (Pichler, 2003). A large body of evidence obtained from immunohistological studies of skin lesions, as well as the generation and analysis of drug-specific T cell lines and T cell clones from allergic patients indicates that drug-specific T cells play a major role in these cutaneous drug eruptions (Pichler, 2003, Hertl and Merk, 1995). In the following the clinical, histological and immunohistological features as well as recent experimental data of maculo-papular exanthems (MPE) are presented.
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Maculo-papular exanthems (MPE)
Erythematous or maculo-papular exanthems have been reported to account for approximately 95% of all drug-induced cutaneous eruptions (Bigby, 2001). Clinically, these exanthems usually appear as erythematous macular or papular eruptions which often start on the trunk and subsequently spread to the extremities in a symmetrical fashion (Fig. 1a). Lesions are often morbilliform, rubeliform or scarlatiniform and can mimic viral or bacterial exanthems. Furthermore, irregularly shaped annular and
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2016, European Journal of Internal MedicineSevere Cutaneous Drug Reactions: Do Overlapping Forms Exist?
2016, Actas Dermo-SifiliograficasCitation Excerpt :Serious cutaneous drug reactions are immune-mediated events that are classed as unexpected adverse drug reactions. Immune-mediated hypersensitivity reactions vary according to the type of cutaneous drug reaction (Table 2).2,3 Thus, in urticarial drug reactions, type i IgE-mediated reactions are activated (Fig. 1) with a rapid clinical onset.
Adverse Drug Reactions
2014, Handbook of Pharmacogenomics and Stratified MedicineCutaneous Drug Reactions in the Pediatric Population
2014, Pediatric Clinics of North AmericaCitation Excerpt :IVc: Perforins, granzyme-B, and Fas ligand are incriminated, activating cytotoxic T cells, natural killer (NK)/T cells, and NK cells clinically manifesting as contact dermatitis, maculopapular rash, and Stevens-Johnson syndrome (SJS)/toxic epidermal necrosis (TEN) exhanthems.9 In bullous exanthems there is a higher percentage of perforin-positive CD8+ killer T cells in the epidermis and dermis.10 IVd: CxCL8 and granulocyte macrophage colony-stimulating factor induce neutrophil activation, and can manifest on the skin as acute generalized exanthematic pustulosis (AGEP).
A review of cutaneous drug eruptions
2013, Clinics in Geriatric MedicineCitation Excerpt :The onset of the reaction typically occurs 1 to 2 weeks after the initiation of the causative medication.16,19 In cases of medication rechallenge, however, the drug eruption may present within a much shorter time frame; the eruptions may even present after the discontinuation of the drug.16,17,19,20 Certain drugs are more likely to evoke a morbilliform eruption.