Recognition and Management of Severe Cutaneous Adverse Drug Reactions (Including Drug Reaction with Eosinophilia and Systemic Symptoms, Stevens-Johnson Syndrome, and Toxic Epidermal Necrolysis)

Med Clin North Am. 2021 Jul;105(4):577-597. doi: 10.1016/j.mcna.2021.04.001.

Abstract

Severe cutaneous adverse reactions to medications (SCARs) include drug reaction with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, toxic epidermal necrolysis, and acute generalized exanthematous pustulosis. They are all non-immunoglobulin E mediated hypersensitivity reaction patterns, distinguished from simple cutaneous drug eruptions by immunologic pathogenesis and internal organ involvement. Herein the clinical features, diagnostic workup, and management considerations are presented for each of these major SCARs.

Keywords: AGEP; Cutaneous drug reaction; DRESS; SCAR; SJS; TEN.

Publication types

  • Review

MeSH terms

  • Acute Generalized Exanthematous Pustulosis / diagnosis
  • Acute Generalized Exanthematous Pustulosis / etiology
  • Acute Generalized Exanthematous Pustulosis / pathology*
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Diagnosis, Differential
  • Drug-Related Side Effects and Adverse Reactions / diagnosis
  • Drug-Related Side Effects and Adverse Reactions / epidemiology
  • Drug-Related Side Effects and Adverse Reactions / pathology*
  • Drug-Related Side Effects and Adverse Reactions / therapy
  • Eosinophilia / chemically induced
  • Eosinophilia / diagnosis*
  • Female
  • Humans
  • Hypersensitivity / immunology
  • Male
  • Middle Aged
  • Pharmacogenetics
  • Prognosis
  • Risk Factors
  • Severity of Illness Index
  • Stevens-Johnson Syndrome / diagnosis
  • Stevens-Johnson Syndrome / etiology*
  • Stevens-Johnson Syndrome / mortality
  • Stevens-Johnson Syndrome / pathology*

Substances

  • Adrenal Cortex Hormones