Drug Eruptions and Hypersensitivity Syndromes

  • Nicole N. Harter
  • Minnelly LuuEmail author


Drug eruptions and hypersensitivity reactions are commonly encountered diagnoses in inpatient pediatric dermatology and can range from simple cutaneous eruptions to severe, life-threatening systemic reactions. Although etiology varies by diagnosis, these reactions are most often triggered by medication exposure and/or infectious agents. In this chapter, we review the presentation, pathogenesis, diagnosis, and management of the most common and/or severe drug and hypersensitivity reactions with emphasis on features distinct in the pediatric population. Case discussions include acute urticaria, urticaria multiforme, erythema multiforme, Stevens–Johnson syndrome, toxic epidermal necrolysis, morbilliform drug eruption, drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, and erythema nodosum. Dermatologists, pediatricians, and inpatient pediatric providers should be familiar with the presentation and differential diagnoses of these conditions and their unique characteristics in children.


Pediatric Children Hypersensitivity Drug eruption Drug reaction Acute urticaria Urticaria multiforme Stevens–Johnson Syndrome (SJS) Toxic epidermal necrolysis (TEN) Morbilliform Drug reaction with eosinophilia and systemic symptoms (DRESS) Acute generalized exanthematous pustulosis (AGEP) Erythema nodosum (EN) 



Acute generalized exanthematous pustulosis


Amino alanine transferase


Anti-nuclear antibody


Anti-streptolysin O


Aspartate amino transferase


Body surface area


Complete blood count


Complete metabolic panel




C-reactive protein




Direct immunofluorescence


Drug-induced hypersensitivity syndrome


Deoxyribonuclease B


Drug reaction with eosinophilia and systemic symptoms


Epstein–Barr virus




Erythema multiforme


Erythema nodosum




Erythrocyte sedimentation rate


Erythema nodosum

Gamma GT

Gamma glutamyl transpeptidase


Granulocyte colony-stimulating factor






Human immunodeficiency virus




Human herpes virus-6


Human leukocyte antigen


Herpes simplex virus


Indirect immunofluorescence






Intravenous immunoglobulin


Liver function test






Non-steroidal anti-inflammatory drug


Neutrophilic urticarial dermatosis




Per Os




Stevens–Johnson syndrome


Staphylococcal scalded skin syndrome


Toxic epidermal necrolysis


Tumor necrosis factor-alpha


White blood cells


Within normal limits


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of DermatologyChildren’s Hospital Los Angeles, Keck School of Medicine of USCLos AngelesUSA

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