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

  • S. Shahzad Mustafa
  • David Ostrov
  • Daniel Yerly
Allergic Skin Diseases (L Fonacier, Section Editor)
  • 721 Downloads
Part of the following topical collections:
  1. Topical Collection on Allergic Skin Diseases

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.

Summary

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

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

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • S. Shahzad Mustafa
    • 1
    • 2
  • David Ostrov
    • 3
  • Daniel Yerly
    • 4
  1. 1.Allergy and Clinical ImmunologyRochester Regional Health SystemRochesterUSA
  2. 2.University of Rochester School of Medicine and DentistryRochesterUSA
  3. 3.Department of Pathology, Immunology and Laboratory MedicineUniversity of Florida College of MedicineGainesvilleUSA
  4. 4.Department of Rheumatology, Immunology and AllergologyUniversity Hospital and University of BernBernSwitzerland

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