Drug-induced cutaneous reactions

Drug-induced cutaneous reactions tend to be immunologic in origin and relate to hypersensitivity, but some reactions are nonallergic. The pathogenesis of fixed-drug reactions is not well understood. 

Bigby M, Jick S, Jick H, Arndt K. Drug-induced cutaneous reactions. A report from the Boston Collaborative Drug Surveillance Program on 15,438 consecutive inpatients, 1975 to 1982. JAMA 1986 256(24) 3358-63. 

Other drug-induced cutaneous reactions - erythema multiforme, erythema nodosum, fixed eruption, necrotizing vasculitis, and others - can have a prominent purpuric component. 

Man CBL, Kwan P, Baum L, Yu E, Lau KM, Cheng AS, Ng MH. Association between HLA-B 1502 allele and antiepileptic drug-induced cutaneous reactions in Han Chinese. Epilepsia 2007 48 1015-8. 

Ruble J, Matsuo H. Anticonvulsant-induced cutaneous reactions. Incidence, mechanisms and management. CNS Drugs 1999 12 215-36. 

Where appropriate, concentrations of drugs for skin and challenge testing, photographs of examples of important drug-induced cutaneous and cutaneous/systemic reactions, structural information, and relevant metabolic pathways are presented. Treatments of drug-induced reactions are beyond the scope of this book and are not considered. 

SED-13, 513) (SEDA-18, 215) (SEDA-22, 216). Three cases of skin reactions (hypersensitivity syndrome reaction, pruritic exanthematous eruption, and acute generalized exanthematous pustulosis) possibly induced by diltiazem have been described and the literature on skin reactions associated with calcium antagonists has been reviewed. The number of diltiazem-induced cutaneous events was significantly greater than those induced by either nifedipine or verapamil. However, there was no difference in the proportion of serious cutaneous adverse events due to any of these three drugs (11). 

A 29-year-old man developed an infiltrative maculo-papular eruption after 1 week of itraconazole 100 mg bd for tinea corporis (44). Itraconazole was withdrawn, and the lesions disappeared within 7 days. Scratch tests, patch tests, scratch-patch tests, and drug induced lymphocyte stimulation tests for itraconazole were negative however, rechallenge with systemic itraconazole induced a maculopapular eruption on the face, hands, and the dorsa of the feet. Empty itraconazole capsules had no cutaneous effects, suggesting an allergic reaction to a metabolite of the compound. 

Post-inflammatory pigmentation can follow a variety of drug-induced inflammatory cutaneous reactions fixed eruptions are known to leave a residual pigmentation that can persist for months. 

Hung SI, Cheeng WH, Jee SH et al (2006) Genetic susceptibility to carbamazepine-induced cutaneous adverse drug reactions. Pharmacogenet Genomics 16 297-306... 

Mockenhaupt M, Schopf E. Epidemiology of drug-induced severe skin reactions. Semin Cutan Med Surg 1996 15 236-243. 

OVERVIEW OF DRUG-INDUCED ADVERSE CUTANEOUS REACTIONS... 

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