drug induced exfoliative dermatitis

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]. CAS 2006;6(4):2658. It could also be useful to use artificial tears and lubricating antiseptic gels. statement and Download Free PDF. 2011;364(12):113443. Exfoliative dermatitis, also known as erythroderma, is an uncommon but serious skin disorder that family physicians must be able to recognize and treat appropriately. Generalized bullous fixed drug eruption is distinct from StevensJohnson syndrome/toxic epidermal necrolysis by immunohistopathological features. Exfoliative Dermatitis Treatment & Management: Medical Care - Medscape Fitzpatricks dermatology in general medicine. Exfoliative dermatitis is characterized by generalized erythema with scaling or desquamation affecting at least 90% of the body surface area. Drug-induced erythroderma invariably recovers completely with prompt initial management and removal of the offending drug. The most commonly used steroids were methylprednisolone, prednisolone and dexamethasone. Huang SH, et al. Antibiotic therapy. Recurrence occurs in around one-third of cases [15] and there is a genetic predisposition for certain Asian groups [16]. Early enteral nutrition has also a protective effect on the intestinal mucosa and decreases bacterial colonization. Fluid balance is a main focus. EDs are serious and potentially fatal conditions. Mockenhaupt M, et al. The more common forms of erythroderma, such as eczema or psoriasis, may persists for months or years and tend to relapse. 2011;50(2):2214. J Allergy Clin Immunol. 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. Exfoliative dermatitis (ED) is defined as diffuse erythema and scaling of the skin involving more than 90% of the total body skin surface area. Apoptosis-inducing factors and lymphocyte-mediated cytotoxicity have been deeply investigated in ED. What are Drug Rashes? Drug reactions are one of the most common causes of exfoliative dermatitis. Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. 1997;19(2):12732. 2011;66(3):3607. 1. Trialon | 40 mg/ml | Injection | ../.. doi: 10.1016/j.jaad.2013.05.003. All non-indispensable drugs have to be stopped because they could alter the metabolism of the culprit agent. Letko E, Papaliodis DN, Papaliodis GN, Daoud YJ, Ahmed AR, Foster CS. (in Chinese) . Erythema multiforme and latent herpes simplex infection. Erythema multiforme StevensJohnson syndrome and toxic epidermal necrolysis. [81]. 1). Gonzalez-Delgado P, et al. The SJS histology is characterized by a poor dermal inflammatory cell infiltrate and full thickness necrosis of epidermis [20, 49]. The approach to treatment should include discontinuation of any potentially causative medications and a search for any underlying malignancy. Bethesda, MD 20894, Web Policies d. Cysts and tumors. Schwartz RA et al. 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. For the prevention of deep venous thrombosis; usually low molecular weight heparin at prophylactic dose are used. Disasters. CAS One of the most common malignancies associated with exfoliative dermatitis is cutaneous T-cell lymphoma, which may not manifest for months or even years after the onset of the skin condition. 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. Theoretically, any drug can trigger a reaction, but the medications most associated with this disorder are: Allopurinol; Antiepileptic medications; Barbiturates Sequelae of exfoliative dermatitis are not widely reported. Ann Burns Fire. 2006;19(4):18891. Patch testing in severe cutaneous adverse drug reactions, including StevensJohnson syndrome and toxic epidermal necrolysis. Here we provide a systematic review on frequency, risk factors, pathogenesis, clinical features and management of patients with drug induced ED. . Clin Exp Allergy. In fact, it was demonstrated that the specificity of the TCR is a required condition for the self-reaction to occur. eCollection 2018. Exfoliative Dermatitis disease: Malacards - Research Articles, Drugs The velocity of infusion should be regulated according to patients arterial pressure with the aim of 30mL/h urinary output (1mL/kg/h in case of a child). 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 Int Arch Allergy Immunol. 1991;97(4):697700. 2008;159(4):9814. A significant number of these patients eventually progress to cutaneous T-cell lymphoma.8, Clinically, the first stage of exfoliative dermatitis is erythema, often beginning as single or multiple pruritic patches, involving especially the head, trunk and genital region. Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Google Scholar. Etanercept: monoclonal antibody against the TNF- receptor. Descamps V, Ranger-Rogez S. DRESS syndrome. Although the etiology is often unknown, exfoliative dermatitis may be the result of a drug reaction or an underlying malignancy. Other clinical findings include lymphadenopathy, hepatomegaly, splenomegaly, edema of the foot or ankle4,6 and gynecomastia.19, The scaling that occurs in exfoliative dermatitis can have severe metabolic consequences, depending on the intensity and the duration of the scaling. Toxic epidermal necrolysis: Part I Introduction, history, classification, clinical features, systemic manifestations, etiology, and immunopathogenesis. Joint Bone Spine. Fernando SL. Pharmacogenet Genom. 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. 2011;20(5):103441. Curr Allergy Asthma Rep. 2014;14(6):442. Comprehensive survival analysis of a cohort of patients with StevensJohnson syndrome and toxic epidermal necrolysis. Epub 2022 Mar 9. Analysis for circulating Szary cells may be helpful, but only if the cells are identified in unequivocally large numbers. Ophthalmologic consultations must be repeated at fixed intervals to avoid the appearance of conjunctival irreversible complications such as chronic conjunctivitis with squamous metaplasia, trichiasis, symblepharon, punctate keratitis and sicca syndrome. Expression of alpha-defensin 1-3 in T cells from severe cutaneous drug-induced hypersensitivity reactions. 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. StevensJohnson syndrome and toxic epidermal necrolysis: a review of the literature. This is particularly true for patients with many comorbidities and poli-drug therapy, where it is advisable to monitor liver and kidney toxicity and to avoid Vitamin A excess [99]. Students also viewed Nostra aetate - Summary Theology: the basics Principles of Risk Management and Insurance Chapters 1-4 J Dermatol. Kirchhof MG, et al. 2008;23(5):54750. Fischer M, et al. An official website of the United States government. 2008;12(5):3559. 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. Sekula P, et al. Lymphocyte transformation test (LTT) performed as described by Pichler and Tilch [77] shows a lower sensitivity in severe DHR compared to less severe DHR [78] but, if available, should be performed within 1week after the onset of skin rash in SJS and TEN [79]. 1996;134(4):7104. Abe R, et al. Locharernkul C, et al. 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. 2004;59(8):80920. Pharmacogenomics J. Drugs such as paracetamol, other non-oxicam NSAIDs and furosemide, bringing a relatively low risk of SJS/TEN a priori, are also highly prevalent as putative culprit agents in large SJS/TEN registries, due to their widespread use in the general population [63, 64] (Table1). Drug-Induced Kidney Injury & Exfoliative Dermatitis: Causes & Reasons of Internal Medicine, University of Bari, Bari, Italy, Andrea Nico,Elisabetta Di Leo,Paola Fantini&Eustachio Nettis, You can also search for this author in Arch Dermatol. 2005;62(4):63842. Cutaneous graft-versus-host diseaseclinical considerations and management. StevensJohnson syndrome and toxic epidermal necrolysis. Verma R, Vasudevan B, Pragasam V. Severe cutaneous adverse drug reactions. 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]. Bookshelf Proc Natl Acad Sci USA. 2014;71(1):1956. A review of DRESS-associated myocarditis. Gout and its comorbidities: implications for therapy. Some of these patients undergo spontaneous resolution. Both hyperthermia and hypothermia are reported. Heat loss is another major concern that accompanies a defective skin barrier in patients with exfoliative dermatitis. Clinical practice. 2015;13(7):62545. doi: 10.1111/dth.15416. official website and that any information you provide is encrypted Epidemiological studies on EM, SJS and TEN syndromes report different results, probably related to several biases, such as ethnical differences, diagnostic criteria and drug consumption patterns in different socio-economic systems. This hypermetabolic state is also furtherly increased by the inflammation present in affected areas. It should be used only in case of a documented positivity of cultural samples. Their occurrence can be prevented by avoiding drug over-prescription and drug associations that interfere with the metabolism of the most frequent triggers [118]. Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Nat Med. Annu Rev Pharmacol Toxicol. Skin reactions to carbamazepine | Semantic Scholar Pregnancy . Huff JC, Weston WL, Tonnesen MG. Erythema multiforme: a critical review of characteristics, diagnostic criteria, and causes. Gastrointest Endosc. Panitumumab Induced Forearm Panniculitis in Two Women With Metastatic 2015;64(3):2779. Br J Dermatol. Clin Exp Dermatol. Medication use and the risk of StevensJohnson syndrome or toxic epidermal necrolysis. Karnes JH, Miller MA, White KD, Konvinse KC, Pavlos RK, Redwood AJ, Peter JG, Lehloenya R, Mallal SA, Phillips EJ. Atypical target lesions manifest as raised, edematous, palpable lesions with only two zones of color change and/or an extensive exanthema with a poorly defined border darker in the center(Fig. Su SC, Hung SI, Fan WL, Dao RL, Chung WH. Google Scholar. The efficacy of intravenous immunoglobulin for the treatment of toxic epidermal necrolysis: a systematic review and meta-analysis. Erythroderma (Exfoliative dermatitis) - Dermatology Advisor Am Fam Physician. . Privacy Medicines have been linked to every type of rash, ranging from mild to life-threatening. Defective regulatory T cells in patients with severe drug eruptions: timing of the dysfunction is associated with the pathological phenotype and outcome. 2022 May;35(5):e15416. The scales may be small or large, superficial or deep. Vasoactive amines may be necessary in case of shock. b. Atopic dermatitis. Hence, the apparent increase in cases of exfoliative dermatitis may be related to the introduction of many new drugs. Typical target lesions consist of three components: a dusky central area or blister, a dark red inflammatory zone surrounded by a pale ring of edema, and an erythematous halo on the periphery. 2010;85(2):131138. Etanercept therapy for toxic epidermal necrolysis. Ann Intern Med. Exfoliative Dermatitis: Symptoms, Causes, and Treatment - WebMD PubMed Central 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]. It characteristically demonstrates diffuse erythema and scaling of greater than 90% of the body surface area. Possible involvement of CD14+CD16+monocyte lineage cells in the epidermal damage of StevensJohnson syndrome and toxic epidermal necrolysis. Applications of Immunopharmacogenomics: Predicting, Preventing, and Understanding Immune-Mediated Adverse Drug Reactions. Barbaud A. It is also extremely important to obtain within the first 24h cultural samples from skin together with blood, urine, nasal, pharyngeal and bronchus cultures. Roujeau JC, Stern RS. [117] described a cohort of ten patients affected by TEN treated with a single dose of etanercept 50mg sc with a rapid and complete resolution and without adverse events. Continue Reading. Antipyretic therapy. government site. Even patients with clear histories of preexisting dermatoses tend to have biopsies that are not diagnostic when they present with erythroderma.2, Laboratory evaluation of patients with erythroderma is generally not very helpful in determining a specific diagnosis. In recent years, clinicians have come to believe that this condition is secondary to a complicated interaction of cytokines and cellular adhesion molecules. Skin eruptions caused by CBZ occur in 24% of the patients on this therapy and include pruritic and erythematous rashes, urticaria, photosensitivity reactions, alterations in skin pigmentation, exfoliative dermatitis, and toxic epidermal necrolysis View on Wiley ncbi.nlm.nih.gov Save to Library Create Alert Cite 12 Citations Citation Type The syndrome has been described previously in association with phenindione administration, leptospirosis and heavy metal poisoning. Herpes simplex virus (HSV) 1 and 2 are the main triggers in young adults (>80% of cases), followed by Epstein-Barr virus (EBV), and Mycoplasma pneumonia [5558]. Topical treatment. Indian J Dermatol. In contrast with DRESS, eosinophilia and atypical lymphocytes are not described in patients with SJS or TEN. Schwartz RA, McDonough PH, Lee BW. Gen Dent. Important data on ED have been obtained by RegiSCAR (European Registry of Severe Cutaneous Adverse Reactions to Drugs: www.regiscar.org), an ongoing pharmaco-epidemiologic study conducted in patients with SJS and TEN. J Dtsch Dermatol Ges. Gueudry J, et al. Tumor necrosis factor : TNF- seems also to play an important role in TEN [41]. Chang CC, et al. Google Scholar. 2013;69(2):1734. 2000;22(5):4137. In vitro diagnostic assays are effective during the acute phase of delayed-type drug hypersensitivity reactions. Fitzpatricks dermatology in general medicine. Unfortunately, the clinical picture does not contribute to an understanding of the underlying cause. 1999;48(5):21726. Despite improved knowledge of the immunopathogenesis of these conditions, immune-modulatory therapies currently used have not been definitively proved to be efficacious [49, 107], and new strategies are urgently needed. f. Drug-induced exfoliative dermatitis is usually short-lived once the inciting medication is withdrawn and appropriate therapy is administered. Advise of potential risk to a fetus and use of effective contraception. Wikizero - Basal-cell carcinoma 2002;118(4):72833. Case Rep Dermatol Med. Allergol Int. Erythema multiforme (photo reproduced with permission of Gary White, MD): typical target lesions (white arrows) together with atypical two-zoned lesions (black arrows). This site needs JavaScript to work properly. Current Perspectives on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. J Allergy Clin Immunol. Oral manifestations of erythema multiforme. 1). 2013;27(3):35664. 2011;128(6):126676. Kamaliah MD, et al. Captopril and Hydrochlorothiazide Tablet Prescribing Information PubMed Exfoliative Dermatitis is a serious skin cell disorder that requires early diagnosis and treatment. [113] retrospectively compared mortality in 64 patients with ED treated either with iv or oral Cys A (35mg/kg) or IVIG (25g/Kg). 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. Rzany B, et al. Ozeki T, et al. 2006;34(2):768. Clinical features; Delayed type hypersensitivity; Drug hypersensitivity; Erythema multiforme; Exfoliative dermatitis; Lyells syndrome; Pathogenesis; StevensJohnson syndrome; Therapy; Toxic epidermal necrolysis. Incidence and drug etiology in France, 1981-1985. It is necessary to obtain as soon as possible a central venous access and to start a continuous monitoring of vital signs. Kostal M, et al. (See paras 3 - 42 and 3- 43.) Schwartz RA, McDonough PH, Lee BW. J Am Acad Dermatol. 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). An extremely rare mucocutaneous adverse reaction following COVID-19 vaccination: Toxic epidermal necrolysis. In the acute phase, before determination of the etiology, treatment consists of measures to soothe the inflamed skin. Mucosal involvement could achieve almost 65% of patients [17]. Journal of Pharmaceutical Research and health Care. Barbaud A. Infliximab: chimeric IgG monoclonal anti-TNF- antibody. Moreover, the time necessary for cells to mature and travel through the epidermis is decreased. Part of 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]. See this image and copyright information in PMC. 00 Comments Please sign inor registerto post comments. Am J Infect Dis. In any case all authors concluded that the blockage of FasL prevents keratinocyte apoptosis [35]. It is also recommended to void larger vesicles with a syringe. If there is a high suspicion of infection without a documented source of infection, broad range empiric therapy should be started. In more severe cases antiviral therapies should be given together with intravenous immunoglobulins [93]. Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist. It should be considered only once the patient is stable and if the skin damage is still ongoing and doesnt respond to other conventional therapies (corticosteroids or IVIG). 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]. 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. 1990;126(1):437. Download. 1996;135(2):3056. PubMed Qilu Pharmaceutical Co., Ltd. GEFITINIB- gefitinib tablet, coated Jang E, Park M, Jeong JE, Lee JY, Kim MG. Sci Rep. 2022 May 12;12(1):7839. doi: 10.1038/s41598-022-11505-0. Adverse cutaneous drug reaction. Lonjou C, et al. Granulysin: Granulysin is a pro-apoptotic protein that binds to the cell membrane by means of charge interaction without the need of a specific receptor, producing a cell membrane disruption, and leading to possible cell death. A useful sign for differential diagnosis is the absence of mucosal involvement, except for conjunctiva. Exfoliative dermatitis has been reported in association with hepatitis, acquired immunodeficiency syndrome, congenital immunodeficiency syndrome (Omenn's syndrome) and graft-versus-host disease.2,1517, In reviews of erythroderma, a significant percentage of patients (about 25 percent) do not receive a specific etiologic diagnosis. Please enable it to take advantage of the complete set of features! Indian J Dermatol. Antibiotics: amoxicillin, ampicillin, ciprofloxacin, demeclocycline , doxycycline , minocycline, nalidixic acid, nitrofurantoin, norfloxacin, penicillin , rifampicin, streptomycin, tetracycline , tobramycin, trimethoprim, trimethoprim + sulphamethoxazole, vancomycin Anticonvulsants : barbiturates, carbamazepine 2007;48(5):10158. Burns. Overall, T cells are the central player of these immune-mediated drug reactions. Other cases are ultimately classifiable as another dermatosis. Takahashi R, et al. PTs have to be performed at least 6months after the recovery of the reaction, and show a variable sensitivity considering the implied drug, being higher for beta-lactam, glycopeptide antibiotics, carbamazepine, lamotrigine, proton pump inhibitors, tetrazepam, trimethoprimsulfametoxazole, pseudoephedrine and ramipril [7376]. Wu PA, Cowen EW. 1998;282(5388):4903. MRY, MGS, EN and GC designed the study, selected scientifically relevant information, wrote and revised the manuscript. Drug reaction with Eosinophilia and systemic symptoms (DRESS) syndrome can mimic SJS and TEN in the early phases, since ED can occur together with the typical maculo-papular rash. Its also characterized by a cell-poor infiltrate, where macrophages and dendrocytes with a strong TNF- immunoreactivity predominate [6, 50]. 2011;71(5):67283. Case Presentation: We report the development of forearm panniculitis in two women during the treatment with Panitumumab (6 mg/Kg intravenous every 2 weeks) + FOLFOX-6 (leucovorin, 5- fluorouracil, and oxaliplatin at higher dosage) for the . Law EH, Leung M. Corticosteroids in StevensJohnson Syndrome/toxic epidermal necrolysis: current evidence and implications for future research. Guidelines for the management of drug-induced liver injury[J]. As described in Table3, major differential diagnosis of EM and SJS/TEN are (1) staphylococcal scalded skin syndrome (SSSS), (2) autoimmune blistering diseases and disseminated fixed bullous drug eruption, (3) others severe delayed DHR [6, 70, 82] (4) Graft versus host disease. Once ED has occurred, it has to be managed in the adequate setting with a multidisciplinary approach, and every effort has to be made to identify and avoid the trigger and to prevent infectious and non-infectious complications.

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