Erythema multiforme drug-induced

NSAIDs can induce a number of other adverse reactions, including bleeding disorders, anemia, thrombocytopenia, erythema nodosum, erythema multiforme, fixed drug eruptions, toxic epidermal necrolysis, Stevens-Johnson syndrome, leukocytocla-sitc vasculitis, recurrent fever with exanthema and, of course, the well-known gastric cytotoxicity. 

A variety of relatively uncommon dermatological side effects have been noted to be associated with antipsychotic agents. These include maculopapular rashes, urticaria, and erythema multiforme (Arana, 2000). Photosensitivity and skin pigmentation can also occur during treatment with these drugs. Although skin pigmentation has been most frequently reported with chlorpromazine, this can occur with thioridazine and trifluoperazine (Harth and Rapoport, 1996). In addition, treatment-induced alopecia has been reported for haloperidol, olanzapine, and risperidone (Mercke et ah, 2000). 

Immune vasculitis can also be induced by drugs. The sulfonamides, penicillin, thiouracil, anticonvulsants, and iodides have all been implicated in the initiation of hypersensitivity angiitis. Erythema multiforme is a relatively mild vasculitic skin disorder that may be secondary to drug hypersensitivity. Stevens-Johnson syndrome is probably a more severe form of this hypersensitivity reaction and consists of erythema multiforme, arthritis, nephritis, central nervous system abnormalities, and myocarditis. It has frequently been associated with sulfonamide therapy. Administration of nonhuman monoclonal or polyclonal antibodies such as rattlesnake antivenin may cause serum sickness. 

One report has presented evidence of a possible association between severe drug-induced erythema multiforme and reactivation of infection with human herpesvirus 6. The reactivation is thought to have contributed in some way to the development of allopurinol hypersensitivity reactions (20). 

Shiohara T, Chiba M, Tanaka Y, Nagashima M. Drug-induced, photosensitive, erythema multiforme-like eruption possible role for cell adhesion molecules in a flare induced by Rhus dermatitis. J Am Acad Dermatol 1990 22(4) 647-50. 

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

Drug-induced erythema multiforme is histologically and even clinically related to fixed drug eruptions. There also seems to be some relationship to Lyell s syndrome, as transitional cases have been observed (Schuppli 1972). 

The etiology is by no means the same in all cases. Erythema multiforme can be caused by various totally unconnected factors. The eruption most commonly arises after infections with herpesviruses or streptococci. In comparison with these, drugs are relatively seldom the cause. However, if drug-induced rashes of erythema multiforme type are included, much larger numbers will be recorded (e.g., ampicillin rashes). 

Erythema multiforme-like symptoms were demonstrated to F. D, and C. Green No. 5 (Fast Green) which is a non-azo dye, approved for use in food, drugs and cosmetics in the United States (Grater 1976). Quinine present in bitter drinks may induce fixed reactions, toxic epidermal necrolysis, or a scarlatiniform rash (Derbes 1964 Calnan and Caron 1961 Callaway and Tate 1974). 

A review summarises the effect of leflunomide on psoriasis and other cutaneous conditions [77 ]. The most common dermatologic complication associated with leflunomide administration is reversible alopecia. However, also more specific conditions have been reported, such as drug-induced subacute cutaneous lupus erythemasosus, erythema multiforme and toxic epidermal necrolysis. 

---