Clinical Phenotypes of Severe Cutaneous Drug Hypersensitivity Reactions

Curr Pharm Des. 2019;25(36):3840-3854. doi: 10.2174/1381612825666191107162921.

Abstract

Drug hypersensitivity reactions are clinically heterogenous ranging from mild to severe. Most drug hypersensitivity reactions are accompanied by cutaneous manifestations. Fever, mucous membrane involvement, large blisters, facial oedema, pustulosis and visceral involvement are clinical features that lead to suspicion of severe adverse drug reactions. Severe cutaneous adverse drug reactions (SCARs) include Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis. Serum sickness like reactions, drug induced vasculitis and generalized bullous fixed drug eruptions are less severe clinical entities. SCARs are uncommon but associated with significant morbidity and mortality. Physician should be aware of specific red flags and danger signs to immediately identify these reactions. Immediate drug withdrawal is mandatory. Early diagnosis and appropriate treatment significantly affect the prognosis of the disease. The purpose of our review is to discuss clinical phenotypes of severe cutaneous drug hypersensitivity reactions.

Keywords: Acute generalized exanthematous pustulosis; drug rash eosinophilia and systemic symptoms; generalized bullous fixed drug eruption; serum-sickness-like reaction; stevens-Johnson syndrome; toxic epidermal necrolysis; vasculitis..

Publication types

  • Review

MeSH terms

  • Acute Generalized Exanthematous Pustulosis
  • Dermatitis, Atopic / classification
  • Dermatitis, Atopic / diagnosis*
  • Drug Hypersensitivity / classification
  • Drug Hypersensitivity / diagnosis*
  • Drug Hypersensitivity Syndrome
  • Humans
  • Phenotype
  • Skin / physiopathology*
  • Stevens-Johnson Syndrome