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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Suggested Reading
Adam J, Pichler WJ, Yerly D. Delayed drug hypersensitivity: models of T-cell stimulation. Br J Clin Pharmacol. 2011;71:701–7.
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.
Bircher AJ. Symptoms and danger signs in acute drug hypersensitivity. Toxicology. 2005;209:201–7.
Calabrese LH, Duna GF. Drug-induced vasculitis. Curr Opin Rheumatol. 1996;8:34–40.
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.
González E, González S. Drug photosensitivity, idiopathic photodermatoses, and sunscreens. J Am Acad Dermatol. 1996;35:871–85.
Halevy S. Acute generalized exanthematous pustulosis. Curr Opin Allergy Clin Immunol. 2009;9:322–8.
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.
Husain Z, Reddy BY, Schwartz RA. DRESS syndrome: part I. Clinical perspectives. J Am Acad Dermatol. 2013a;68:693.e1–14.
Husain Z, Reddy BY, Schwartz RA. DRESS syndrome: part II. Management and therapeutics. J Am Acad Dermatol. 2013b;68:709.e1–9.
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.
Lee AY. Fixed drug eruptions. Incidence, recognition, and avoidance. Am J Clin Dermatol. 2000;1:277–85.
Lerch M, Pichler WJ. The immunological and clinical spectrum of delayed drug-induced exanthems. Curr Opin Allergy Clin Immunol. 2004;4:411–9.
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.
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.
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.
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.
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.
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.
Shiohara T. Fixed drug eruption: pathogenesis and diagnostic tests. Curr Opin Allergy Clin Immunol. 2009;9:316–21.
Tan SC, Tan JW. Symmetrical drug-related intertriginous and flexural exanthema. Curr Opin Allergy Clin Immunol. 2011;11:313–8.
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.
Wilson EE, Malinak LR. Vulvovaginal sequelae of Stevens-Johnson syndrome and their management. Obstet Gynecol. 1988;71:478–80.
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.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights 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)