Skip to main content

Principles of Treatment of Cutaneous Drug Eruptions

  • Chapter
Cutaneous Drug Eruptions

Abstract

Cutaneous drug eruptions are a major health concern and may affect up to 1 % of patients taking systemic medications, and are seen in 2–3 % of hospitalized patients. Most reactions are mild and self-limited upon discontinuation of the medication, but severe and life-threatening reactions are also possible. Appropriate management of patients requires a thorough knowledge of the spectrum of drug reactions, the culpability of suspected medications based on reaction type and timing, patient-specific risk factors for drug reactions, and treatment options to limit mortality and sequelae of drug reactions. Drug reactions can be either acute (e.g., urticaria, exanthematous eruptions, and Stevens Johnson syndrome) or chronic (e.g., acneiform, pigmentary, and psoriasiform eruptions). This chapter will focus on the treatment principles of the acute cutaneous drug eruptions.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Suggested Reading

  • Adam J, Pichler WJ, Yerly D. Delayed drug hypersensitivity: models of T-cell stimulation. Br J Clin Pharmacol. 2011;71:701–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Aota N, Shiohara T. Viral connection between drug rashes and autoimmune diseases: how autoimmune responses are generated after resolution of drug rashes. Autoimmun Rev. 2009;8:488–94.

    Article  CAS  PubMed  Google Scholar 

  • Bircher AJ. Symptoms and danger signs in acute drug hypersensitivity. Toxicology. 2005;209:201–7.

    Article  CAS  PubMed  Google Scholar 

  • Calabrese LH, Duna GF. Drug-induced vasculitis. Curr Opin Rheumatol. 1996;8:34–40.

    Article  CAS  PubMed  Google Scholar 

  • Dorafshar AH, Dickie SR, Cohn AB, Aycock JK, O’Connor A, Tung A, et al. Antishear therapy for toxic epidermal necrolysis: an alternative treatment approach. Plast Reconstr Surg. 2008;122:154–60.

    Article  CAS  PubMed  Google Scholar 

  • González E, González S. Drug photosensitivity, idiopathic photodermatoses, and sunscreens. J Am Acad Dermatol. 1996;35:871–85.

    Article  PubMed  Google Scholar 

  • Halevy S. Acute generalized exanthematous pustulosis. Curr Opin Allergy Clin Immunol. 2009;9:322–8.

    Article  PubMed  Google Scholar 

  • Huang YC, Li YC, Chen TJ. The efficacy of intravenous immunoglobulin for the treatment of toxic epidermal necrolysis: a systematic review and meta-analysis. Br J Dermatol. 2012;167:424–32.

    Article  CAS  PubMed  Google Scholar 

  • Husain Z, Reddy BY, Schwartz RA. DRESS syndrome: part I. Clinical perspectives. J Am Acad Dermatol. 2013a;68:693.e1–14.

    Article  CAS  Google Scholar 

  • Husain Z, Reddy BY, Schwartz RA. DRESS syndrome: part II. Management and therapeutics. J Am Acad Dermatol. 2013b;68:709.e1–9.

    Article  CAS  Google Scholar 

  • Kardaun SH, Sekula P, Valeyrie-Allanore L, Liss Y, Chu CY, Creamer D, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. Br J Dermatol. 2013;169:1071–80.

    Article  CAS  PubMed  Google Scholar 

  • Lee AY. Fixed drug eruptions. Incidence, recognition, and avoidance. Am J Clin Dermatol. 2000;1:277–85.

    Article  CAS  PubMed  Google Scholar 

  • Lerch M, Pichler WJ. The immunological and clinical spectrum of delayed drug-induced exanthems. Curr Opin Allergy Clin Immunol. 2004;4:411–9.

    Article  CAS  PubMed  Google Scholar 

  • Paradisi A, Abeni D, Bergamo F, Ricci F, Didona D, Didona B. Etanercept therapy for toxic epidermal necrolysis. J Am Acad Dermatol. 2014;71:278–83.

    Article  CAS  PubMed  Google Scholar 

  • Pichler WJ, Adam J, Daubner B, Gentinetta T, Keller M, Yerly D. Drug hypersensitivity reactions: pathomechanism and clinical symptoms. Med Clin North Am. 2010;94:645–64.

    Article  CAS  PubMed  Google Scholar 

  • Reese D, Henning JS, Rockers K, Ladd D, Gilson R. Cyclosporine for SJS/TEN: a case series and review of the literature. Cutis. 2011;87:24–9.

    PubMed  Google Scholar 

  • Roujeau JC, Bastuji-Garin S. Systematic review of treatments for Stevens-Johnson syndrome and toxic epidermal necrolysis using the SCORTEN score as a tool for evaluating mortality. Ther Adv Drug Saf. 2011;2:87–94.

    Article  PubMed Central  PubMed  Google Scholar 

  • Schneck J, Fagot JP, Sekula P, Sassolas B, Roujeau JC, Mockenhaupt M. Effects of treatments on the mortality of Stevens-Johnson syndrome and toxic epidermal necrolysis: a retrospective study on patients included in the prospective EuroSCAR Study. J Am Acad Dermatol. 2008;58:33–40.

    Article  PubMed  Google Scholar 

  • Schwartz RA, McDonough PH, Lee BW. Toxic epidermal necrolysis: part II. Prognosis, sequelae, diagnosis, differential diagnosis, prevention, and treatment. J Am Acad Dermatol. 2013;69:187.e1–16.

    Article  CAS  Google Scholar 

  • Shiohara T. Fixed drug eruption: pathogenesis and diagnostic tests. Curr Opin Allergy Clin Immunol. 2009;9:316–21.

    Article  PubMed  Google Scholar 

  • Tan SC, Tan JW. Symmetrical drug-related intertriginous and flexural exanthema. Curr Opin Allergy Clin Immunol. 2011;11:313–8.

    Article  PubMed  Google Scholar 

  • Wei CY, Ko TM, Shen CY, Chen YT. A recent update of pharmacogenomics in drug-induced severe skin reactions. Drug Metab Pharmacokinet. 2012;27:132–41.

    Article  CAS  PubMed  Google Scholar 

  • Wilson EE, Malinak LR. Vulvovaginal sequelae of Stevens-Johnson syndrome and their management. Obstet Gynecol. 1988;71:478–80.

    CAS  PubMed  Google Scholar 

  • Wolkenstein P, Latarjet J, Roujeau JC, Duguet C, Boudeau S, Vaillant L, et al. Randomised comparison of thalidomide versus placebo in toxic epidermal necrolysis. Lancet. 1998;352:1586–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cindy E. Owen MD, MS .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

Owen, C.E., Callen, J.P. (2015). Principles of Treatment of Cutaneous Drug Eruptions. In: Hall, J., Hall, B. (eds) Cutaneous Drug Eruptions. Springer, London. https://doi.org/10.1007/978-1-4471-6729-7_4

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-6729-7_4

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6728-0

  • Online ISBN: 978-1-4471-6729-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics