Severe Cutaneous Adverse Drug Reactions: Presentation, Risk Factors, and Management

Abstract

Purpose of study: Immune-mediated adverse drug reactions occur commonly in clinical practice and include mild, self-limited cutaneous eruptions, IgE-mediated hypersensitivity, and severe cutaneous adverse drug reactions (SCAR). SCARs represent an uncommon but potentially life-threatening form of delayed T cell-mediated reaction. The spectrum of illness ranges from acute generalized exanthematous pustulosis (AGEP) to drug reaction with eosinophilia with systemic symptoms (DRESS), to the most severe form of illness, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).

Recent findings: There is emerging literature on the efficacy of cyclosporine in decreasing mortality in SJS/TEN. The purpose of our review is to discuss the typical presentations of these conditions, with a special focus on identifying the culprit medication. We review risk factors for developing SCAR, including HLA alleles strongly associated with drug hypersensitivity. We conclude by discussing current strategies for the management of these conditions.

Keywords: Acute generalized exanthematous pustulosis (AGEP); Drug reaction with eosinophilia and systemic symptoms (DRESS); HLA-associated drug hypersensitivity; Severe cutaneous adverse drug reaction (SCAR); Stevens-Johnson syndrome (SJS); Toxic epidermal necrolysis (TEN).