drug induced exfoliative dermatitis

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. 2013;69(2):187. 2008;49(12):208791. Increased peripheral blood flow can result in high-output cardiac failure. 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). 2014;70(3):53948. Applications of Immunopharmacogenomics: Predicting, Preventing, and Understanding Immune-Mediated Adverse Drug Reactions. 2012;66(6):e22936. Gout and its comorbidities: implications for therapy. Nassif A, et al. If cutaneous pathology also mimics cutaneous T-cell lymphoma, it can be very difficult to differentiate a drug-induced skin condition from exfoliative dermatitis associated with a malignancy.2,9. The type of rash that happens depends on the medicine causing it and your response. Article Nutritional support. If there is a high suspicion of infection without a documented source of infection, broad range empiric therapy should be started. Staphylococcal Scalded Skin Syndrome: criteria for Differential Diagnosis from Lyells Syndrome. The incidence of cutaneous adverse drug reactions (CADRs) is high in HIV-infected persons; however, there are large gaps in knowledge about several aspects of HIV-associated CADRs in Africa, which carries the biggest burden of the disease. 583-587. Erythema multiforme (photo reproduced with permission of Gary White, MD): typical target lesions (white arrows) together with atypical two-zoned lesions (black arrows). 2009;151(7):5145. J Invest Dermatol. . It is challenging to diagnose this syndrome due to the variety . In patients with SJS/TEN increased serum levels of retinoid acid have been found. Roujeau JC, et al. 2013;27(3):35664. Drugs.com provides accurate and independent information on more than . Immune-histopathological features allow to distinguish generalized bullous drug eruption from SJS/TEN [36]. 543557. Check the full list of possible causes and conditions now! Fritsch PO. . J Am Acad Dermatol. Malignancies are a major cause of exfoliative dermatitis. Immunoregulatory effector cells in drug-induced toxic epidermal necrolysis. Huang SH, et al. Mona-Rita Yacoub. It is necessary to obtain as soon as possible a central venous access and to start a continuous monitoring of vital signs. sharing sensitive information, make sure youre on a federal The action of antithyroid drugs may be delayed in amiodarone-induced thyrotoxicosis because of substantial quantities of preformed thyroid hormones stored in the gland. Main discriminating factors between EMM, SJS, SJS-TEN, TEN and SSSS is summarized in Table3 [84]. Sekula P, et al. J Clin Apher. loss of taste Derm: stevens-johnson syndrome, toxic epidermal necrolysis, rash, exfoliative dermatitis, hair . Granulysin is a key mediator for disseminated keratinocyte death in StevensJohnson syndrome and toxic epidermal necrolysis. 2000;115(2):14953. 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. Toxic epidermal necrolysis associated with severe cytomegalovirus infection in a patient on regular hemodialysis. Ned Tijdschr Geneeskd. J Am Acad Dermatol. Exfoliative dermatitis is a dangerous form of CADR which needs immediate withdrawl of all the four drugs. Arch Dermatol. In contrast with DRESS, eosinophilia and atypical lymphocytes are not described in patients with SJS or TEN. 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. Joint Bone Spine. Fournier S, et al. Wetter DA, Camilleri MJ. Clin Exp Dermatol. A promising and complementary in vitro tool has been used by Polak ME et al. These patches tend to spread until, after a matter of days or weeks, most of the skin surface is covered with an erythematous, pruritic eruption. Clipboard, Search History, and several other advanced features are temporarily unavailable. The efficacy of intravenous immunoglobulin for the treatment of toxic epidermal necrolysis: a systematic review and meta-analysis. Google Scholar. Although the etiology is. Google Scholar. 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]. Overall, T cells are the central player of these immune-mediated drug reactions. Interstitial nephritis is common in DRESS syndrome, occurring roughly in 40% of cases, whereas pre-renal azotemia may occur in SJS and TEN. Iv bolus of steroid (dexamethasone 100300mg/day or methylprednisolone 2501000mg/day) for 3 consecutive days with a gradual taper steroid therapy is sometimes advised. Analysis of StevensJohnson syndrome and toxic epidermal necrolysis using the Japanese Adverse Drug Event Report database. Oliveira L, Zucoloto S. Erythema multiforme minor: a revision. In SJS, SJS/TEN and TEN the efficacy of corticosteroids is far from being demonstrated. Students also viewed Nostra aetate - Summary Theology: the basics Principles of Risk Management and Insurance Chapters 1-4 The exact role of FasL in the pathogenesis of toxic epidermal necrolysis is still questionable especially because a correlation between serum FasL levels and disease severity has not been established and because its levels have been found to be increased also in drug-induced hypersensitivity syndrome and maculopapular eruption [36]. Curr Opin Allergy Clin Immunol. d. Cysts and tumors. . Careers. Erythema multiforme (EM), StevensJohnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Wetter DA, Davis MD. Jarrett P, et al. It is a reaction pattern and cutaneous manifestation of a myriad of underlying ailments, including psoriasis and eczema, or a reaction to the consumption of . California Privacy Statement, doi: 10.4103/0019-5154.39732. 2011;18:e12133. Continue Reading. 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 A switch to oral therapy can be performed once the mucosal conditions improve. Clinical and Molecular Allergy Hospitalization is usually necessary for initial evaluation and treatment. b. Atopic dermatitis. 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. For these reasons, patients should be admitted to intensive burn care units or in semi-intensive care units where they may have access to sterile rooms and to dedicated medical personnel [49, 88]. Clinical features; Delayed type hypersensitivity; Drug hypersensitivity; Erythema multiforme; Exfoliative dermatitis; Lyells syndrome; Pathogenesis; StevensJohnson syndrome; Therapy; Toxic epidermal necrolysis. Am J Clin Dermatol. Mortality rate of patients with TEN has shown to be directly correlated to SCORTEN, as shown in Fig. Ethambutol Induced Exfoliative Dermatitis. 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. Antibiotic therapy. When it precedes cutaneous T-cell lymphoma lesions, exfoliative dermatitis becomes the presenting sign of the underlying malignancy. The authors concluded for a potential beneficial effect of Cys A and a possible improvement in survival compared to IVIG. The syndrome has been described previously in association with phenindione administration, leptospirosis and heavy metal poisoning. However, according to a consensus definition [54], EMM syndrome has been separated from SJS/TEN spectrum. Smith SD, et al. Blood counts and bone marrow studies may reveal an underlying leukemia. 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]. The dermis shows an inflammatory infiltrate characterized by a high-density lichenoid infiltrate rich in T cells (CD4+ more than CD8+) with macrophages, few neutrophils and occasional eosinophils; the latter especially seen in cases of DHR [5, 50]. Stevens-Johnson syndrome and toxic epidermal necrolysis due to anticonvulsants share certain clinical and laboratory features with drug-induced hypersensitivity syndrome, despite differences in cutaneous presentations. An official website of the United States government. In patients with this disorder, the mitotic rate and the absolute number of germinative skin cells are higher than normal. Curr Allergy Asthma Rep. 2014;14(6):442. 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. Fitzpatricks dermatology in general medicine. If it is exfoliative dermatitis that's drug induced, it's easy to treat . [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] Chung WH, Hung SI. Br J Dermatol. Background: Panitumumab is an EGFR inhibitor used for the treatment of metastatic colorectal cancer (mCRC), even if its use is related to skin toxicity. Schneck J, et al. 2013;57(4):58396. T and NK lymphocytes can produce FasL that eventually binds to target cells. The applications of topical cyclosporine and autologous serum have also been showed to be useful in refractory cases [103]. Toxic epidermal necrolysis and StevensJohnson syndrome. Rzany B, et al. Four main pathways have been found to play important roles in the pathogenesis of keratinocyte death: (1) Fas-FasL interaction, (2) Perforin/granzyme B pathway, (3) Granulysin and (4) Tumor necrosis factor (TNF-) [26]. J Am Acad Dermatol. EM is a self-limited skin condition mainly associated with infections and drugs [53, 54]. A pseudolymphoma reaction with fever, arthralgias, lymphadenopathy, hepatosplenomegaly, anemia and erythroderma may develop as a result of hypersensitivity to dapsone or antiepileptic drugs. Allergy. A severity-of-Illness score for toxic epidermal necrolysis (SCORTEN) has been proposed and validated to predict the risk of death at admission [81]. Br J Dermatol. It is a clinical manifestation and usually associated with various underlying cutaneous disorders, drug induced reactions and malignancies. 2011;364(12):113443. 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. Recurrence occurs in around one-third of cases [15] and there is a genetic predisposition for certain Asian groups [16]. Rheumatology (Oxford). 1991;97(4):697700. Ko TM, et al. 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].

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