[Mechanisms of cutaneous drug reactions]

Two main mechanisms, pharmacologic and immunoallergic, are responsible for cutaneous reactions to drugs. Pharmacologic mechanisms can be predictable (overdosage, cumulative or delayed toxicity, adverse effects) or unpredictable (idiosyncratic, intolerance, or anaphylactic reaction). Immunoallergic mechanisms can be mediated by IgE (some types of urticaria and anaphylactic shock), due to circulating immune complexes (leukocytoclastic vasculitis, serum sickness-type reactions) or mediated by lymphocytes (exanthema, Lyell's syndrome, fixed pigmented erythema, photosensitization). The diagnostic work-up varies according to the causative mechanism. When the reaction is predictable, the responsible drug can be identified according to the data in the present bibliography. When the reaction is immunologic, only the chronologic sequence of events can identify the responsible drug. The risk of recurrence with an identical or related molecule also varies according to the causative mechanism. For urticaria, diagnosis and the risk of recurrence differ according to whether the cause is allergic (mediated by IgE or urticarial vasculitis) or is pharmacologic (urticaria due to aspirin or to conversion enzyme inhibitors).