drug induced exfoliative dermatitis drug induced exfoliative dermatitis

CAS Exfoliative dermatitis is characterized by generalized erythema with scaling or desquamation affecting at least 90% of the body surface area. Even though exfoliative dermatitis is a complex disorder involving many factors, the underlying disease is usually the key determinant of the course and prognosis. 2003 Oct 25;147(43):2089-94. Moreover Mawson A and colleagues hypothesized that the efficacy of plasmapheresis is able to reduce serum level of vitamin A. 2009;29(3):51735. Insidious development of the erythroderma, progressive debilitation of the patient, absence of previous skin disease and resistance to standard therapy are features that may suggest an underlying malignancy.6,11, Erythroderma is also associated with disorders that cannot easily be classified into groups. Kreft B, et al. 2013;69(2):173174. Corticosteroids could also reduce the amount of keratinocytes apoptosis and the activation of caspases [105]. Orton PW, et al. An increased metabolism is typical of patients with extended disepithelizated areas. Exfoliative dermatitis is a dangerous form of CADR which needs immediate withdrawl of all the four drugs. Do this 2 to 3 times a week. It is a clinical manifestation and usually associated with various underlying cutaneous disorders, drug induced reactions and malignancies. 2001;108(5):83946. J Dermatol. Erythroderma (literally, "red skin"), also sometimes called exfoliative dermatitis, is a severe and potentially life-threatening condition that presents with diffuse erythema and scaling involving all or most of the skin surface area (90 percent, in the most common definition). Here we provide a systematic review on frequency, risk factors, pathogenesis, clinical features and management of patients with drug induced ED. Download. The incidence of erythema multiforme, StevensJohnson syndrome, and toxic epidermal necrolysis. Valeyrie-Allanore L, et al. Curr Allergy Asthma Rep. 2014;14(6):442. 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. ALDEN has shown a good accuracy to assess drug causality compared to data obtained by pharmacovigilance method and casecontrol results of the EuroSCAR casecontrol analysis for drugs associated with TEN. More than moderate, unresponsive to treatment, and which interferes with the Soldier's perfor-mance of duty. Erythema multiforme. 1995;333(24):16007. To confirm ATT induced erythroderma and narrow down the offending agents, sequential rechallenge with ATT was done and again these patients had similar lesions erupt all over the body only with isoniazid and pyrazinamide. 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. Management of patients with a suspected drug induced exfoliative dermatitis, acute generalized exanthematous pustulosis, algorithm of drug causality for epidermal necrolysis, European registry of severe cutaneous adverse reactions to drugs. J Am Acad Dermatol. The approach to treatment should include discontinuation of any potentially causative medications and a search for any underlying malignancy. 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. In conclusion, therapy wth IVIG should be started within the first 5days and an high-dosage regimen should be preferred (2.54g/kg for adults and 0.251.5g/kg in children divided in 35days). Nassif A, et al. The EuroSCAR-study. Med J Armed Forces India. J Immunol. Because a certain degree of cross-reactivity between the various aromatic anti-epileptic drugs exists, some HLAs have been found to be related to SJS/TEN with two drugs, as the case of HLA-B*1502 with both phenytoin and oxcarbazepine [32]. Hence, the apparent increase in cases of exfoliative dermatitis may be related to the introduction of many new drugs. Paradisi A, et al. Wolkenstein P, et al. CAS Blood gas analysis, glucose and creatinine levels together with electrolytes should be evaluated and therapy should be modified accordingly. 2014;70(3):53948. 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. In particular, drug induced exfoliative dermatitis (ED) are a group of rare and more severe drug hypersensitivity reactions (DHR) involving skin and mucous membranes and usually occurring from days to several weeks after drug exposure [2]. 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]. Kirchhof MG et al. Pharmacogenetics studies have found an association between susceptibility to recurrent EM in response to several stimuli and human leukocyte antigen (HLA) haplotypes of class II, in particular HLA DQB1*0301 [23]. Toxic epidermal necrolysis: Part II Prognosis, sequelae, diagnosis, differential diagnosis, prevention, and treatment. Curr Opin Allergy Clin Immunol. volume14, Articlenumber:9 (2016) In more severe cases antiviral therapies should be given together with intravenous immunoglobulins [93]. doi: 10.1016/j.jaad.2013.05.003. In EMM their efficacyis demonstrated in controlling the evolution of the disease [106]. Science. Copyright 2023 American Academy of Family Physicians. (5.7, 8.1, 8.3) ADVERSE REACTIONS The most commonly reported adverse drug reactions (ADRs), reported in more than 20% of the patients and greater than placebo were skin reactions and diarrhea . Semin Dermatol. Plasmapheresis may have a role in the treatment of ED because it removes Fas-L [96], other cytokines known to be implied in the pathogenesis (IL-6, IL-8, TNF-) [97, 98]. J Am Acad Dermatol. Exfoliative dermatitis, including Stevens-Johnson syndrome, drug rash with eosinophilia and systemic symptoms, and toxic epidermal necrolysis, has occurred with anti-PD-1/PD-L1 treatments. Case Rep Dermatol. All the linen must be sterile. Beneficial effect of plasma exchange in the treatment of toxic epidermal necrolysis: a series of four cases. CAS 1995;14(6):5589. The efficacy of intravenous immunoglobulin for the treatment of toxic epidermal necrolysis: a systematic review and meta-analysis. Exfoliative dermatitis may happen as a complication of other skin issues. Br J Dermatol. Drugs that have been implicated in the causation of LPP include captopril, cinnarizine, ramipril, simvastatin, PUVA, and antituberculous medications. The management of toxic epidermal necrolysis. PubMed 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]. Immunoregulatory effector cells in drug-induced toxic epidermal necrolysis. Skin testing in delayed reactions to drugs. It is also recommended to void larger vesicles with a syringe. Schneck J, et al. Int J Mol Sci. Advise of potential risk to a fetus and use of effective contraception. EM is a self-limited skin condition mainly associated with infections and drugs [53, 54]. Lin YT, et al. Downey A, et al. eCollection 2018. These levels could reflect the interaction between culprit drugs and aldehyde dehydrogenase that is the enzyme which metabolizes retinoid acid. 8600 Rockville Pike Abe J, et al. However, according to a consensus definition [54], EMM syndrome has been separated from SJS/TEN spectrum. An epidemiologic study from West Germany. Disasters. Google Scholar. Although the etiology is often unknown, exfoliative dermatitis may be the result of a drug reaction or an underlying malignancy. Painkiller therapy. A slow acetylator genotype is a risk factor for sulphonamide-induced toxic epidermal necrolysis and StevensJohnson syndrome. Malignancies are a major cause of exfoliative dermatitis. Samim F, et al. Clinical clues of a drug-induced etiology include: Abrupt onset, previous morbilliform eruption, multiple, varied cutaneous morphologic lesions present together Extensive erythema is followed in 2-6 days by exfoliative scaling Pruritus can be severe, leading to scratching and lichenification in more chronic processes CAS All non-indispensable drugs have to be stopped because they could alter the metabolism of the culprit agent. They found that the inhibition of these molecules could attenuate the cytotoxic effect of lymphocytes toward keratinocytes. 2019 Jan 6;59:463-486. doi: 10.1146/annurev-pharmtox-010818-021818. HLA DQB1* 0301 allele is involved in the susceptibility to erythema multiforme. Barbaud A. These include a cutaneous reaction to other drugs, exacerbation of a previously existing condition, infection, metastatic tumor involvement, a paraneoplastic phenomenon, graft-versus-host disease, or a nutritional disorder. The therapeutic approach of EMM, SJS, TEN depends on extension of skin, mucosal involvement and systemic patients conditions. 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. 2013;168(3):55562. Apoptosis as a mechanism of keratinocyte death in toxic epidermal necrolysis. Not responsive to therapy. 2008;12(5):3559. They usually have fever, are dyspneic and cannot physiologically feed. Fernando SL. . Contact dermatitis from topical antihistamine . The induction dosage in EMM is usually 1mg/kg/day that should be maintained until a complete control of the skin is obtained. Arch Dermatol. Erythema multiforme (EM), Stevens- Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Synthetic bilaminar membranes with silver nitrate have also a role in skin repairing and avoid protein loss through the damaged skin [100, 101]. 1991;127(6):83942. N Engl J Med. [81]. Staphylococcal Scalded Skin Syndrome: criteria for Differential Diagnosis from Lyells Syndrome. 2022 May;35(5):e15416. Add 1 cup (about 236 milliliters) of vinegar to a bathtub filled with warm water. If necessary, it can be repeated every 68h. NSAIDs should be avoided as they can induce ED as well. Ibuprofen Zentiva is a drug based on the active ingredient ibuprofen (DC.IT) (FU), belonging to the category of NSAID analgesics and specifically derivatives of propionic acid. Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Kano Y, et al. Fitzpatricks dermatology in general medicine. Association between HLA-B* 1502 allele and antiepileptic drug-induced cutaneous reactions in Han Chinese. 2008;14(12):134350. 2006;19(4):18891. Guidelines for the management of drug-induced liver injury[J]. 2015;13(7):62545. 1994;331(19):127285. f. Huff JC, Weston WL, Tonnesen MG. Erythema multiforme: a critical review of characteristics, diagnostic criteria, and causes. 2011;3(1):e2011004. Drug induced exfoliative dermatitis: state of the art, https://doi.org/10.1186/s12948-016-0045-0, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Proc Natl Acad Sci USA. Tohyama M, Hashimoto K. Immunological mechanisms of epidermal damage in toxic epidermal necrolysis. Furosemide or ethacrynic acid may be required to maintain an adequate urinary output [90]. 1. 2008;53(1):28. Plasmapheresis. Australas J Dermatol. [49] confirmed these results and even suggested that higher dosage regimen with 2.74g/kg seem to be more effective in survival outcome. Descamps V, Ranger-Rogez S. DRESS syndrome. Paquet P, et al. This content is owned by the AAFP. Etanercept therapy for toxic epidermal necrolysis. In the hospital, special attention must be given to maintaining temperature control, replacing lost fluids and electrolytes, and preventing and treating infection. government site. 2008;23(5):54750. [Erythema multiforme vs. Stevens-Johnson syndrome and toxic epidermal necrolysis: an important diagnostic distinction]. Shared and restricted T-cell receptor use is crucial for carbamazepine-induced Stevens-Johnson syndrome. 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. In approximately 25% of people, there is no identifiable cause. Ganciclovir and cidofovir should be used when polymerase-chain reactions (PCR) on peripheral blood or other biological sample identifies a viral reactivation (HHV6, HHV7, EBV and CMV). The most commonly used steroids were methylprednisolone, prednisolone and dexamethasone. A recently published meta-analysis by Huang [110] and coworkers on IVIG in SJS/SJS-TEN/TEN reviewed 17 studies with 221 patients and compared the results obtained with high-dosage IVIG (>2g/kg) compared to lower-dosage IVIG (<2g/kg). Br J Dermatol. 2, and described below. Epub 2018 Aug 22. PubMed Association of HLA-B*1502 allele with carbamazepine-induced toxic epidermal necrolysis and StevensJohnson syndrome in the multi-ethnic Malaysian population. Rabelink NM, Brakman M, Maartense E, Bril H, Bakker-Wensveen CA, Bavinck JN. J Am Acad Dermatol. Stern RS. Strom BL, et al. Pichler WJ, Tilch J. J Pharm Health Care Sci. Exanthematous drug eruptions. Erythema multiforme StevensJohnson syndrome and toxic epidermal necrolysis. 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. Drug-induced LPP. Epilepsia. In EM a lymphocytic infiltrate (CD8+ and macrophages), associated with vacuolar changes and dyskeratosis of basal keratinocytes, is found along the dermo-epidermal junction, while there is a moderate lymphocytic infiltrate around the superficial vascular plexus [20]. Li X, et al. Mayo Clin Proc. 2002;65(9):186170. When less than 10% of the body surface area (BSA) is involved, it is defined SJS, when between 10 and 30% of BSA it is defined overlapping SJS/TEN, when more than 30% of BSA, TEN [2] (Additional file 1: Figure S1, Additional file 2: Figure S2). Article View ABRIGO_Worksheet #8 Drug Study_Endocrine System.pdf from NCM 06 at Southern Luzon State University (multiple campuses). Amphotericin B injection and potassium-depleting agents: When corticosteroids are administered concomitantly with potassium-depleting agents (ie, amphotericin B, diuretics), patients should be observed closely for development of hypokalemia.There have been cases reported in which concomitant . It is advised against the use of silver sulfadiazine because sulphonamide can be culprit agents. (scFv) (directed against Dsg1/3) or AK23 (directed against Dsg3) with (as a control) or without exfoliative toxin A (ETA). An official website of the United States government. Increased peripheral blood flow can result in high-output cardiac failure. Theoretically, any drug may cause exfoliative dermatitis. Allergy. Drug specific cytotoxic T-cells in the skin lesions of a patient with toxic epidermal necrolysis. Autologous transplantation of mesenchymal umbilical cord cells seems also to be highly efficacious [102]. 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. J Clin Apher. Apoptosis-inducing factors and lymphocyte-mediated cytotoxicity have been deeply investigated in ED.