Severe cutaneous adverse reactions

• DRESS syndrome
  • Drug-related eosinophilia and systemic symptoms
    • Also called drug-induced hypersensitivity syndrome
  • Drugs
    • Allopurinol
    • Antiepileptics
    • Antibiotics
  • Risk factors
    • Older age
    • Renal failure
    • Certain HLA alleles
  • Clinical features
    • Fever
    • Pruritic morbilliform rash
    • Facial oedema
  • Multiorgan failure can occur
  • Fatal in 10%
  • Treatment
    • Drug cessation
    • Steroids
• Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS)
  • If < 10% of skin surface is involved -> SJS
  • If 10 – 30% of skin surface is involved -> SJS/TEN overlap
  • If > 30% of skin surface is involved -> TEN
  • Drugs
    • Antibiotics
    • Antiepileptics
    • Sulpha drugs
    • Allopurinol
  • Risk factors
    • HIV infection
  • Clinical features
    • High fever
    • Painful erythematous macules
    • -> Lesions form bullae
    • -> Extensive, full-thickness epidermal necrosis and sloughing
    • Resembles superficial burns
    • Mucous membranes almost always involved
      • Stomatitis
      • Oral ulcers
      • Conjunctivitis
      • Urethritis
    • Circulatory shock
  • Diagnosis
    • Clinical
    • Positive Nikolsky sign
  • Treatment
    • Supportive care
    • Drug cessation
    • High-dose steroid
    • IV immunoglobulin
    • GM-CSF
  • Mortality 10 – 50%
• Acute generalized exanthematous pustulosis (AGEP)
  • Drugs
    • Penicillins
    • Quinolones
    • Sulpha drugs
  • Clinical features
    • Erythematous, oedematous pustules
    • Begin in intertriginous areas, progress over the whole body
    • Fever
  • Treatment
    • Drug cessation
    • Antipyretics
    • Oral steroids