Related Experiment Video
Updated: May 18, 2026
07:22
A Standardized Procedure of Dressing Management for Toxic Epidermal Necrolysis
Published on: March 14, 2025
Toxic epidermal necrolysis, DRESS, AGEP: do overlap cases exist?
Sophie Bouvresse1, Laurence Valeyrie-Allanore, Nicolas Ortonne
1Department of Dermatology, Referral center for toxic and auto-immune blistering diseases, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris Université Paris-Est Créteil, Créteil Cedex, F-94010, France.
Orphanet Journal of Rare Diseases
|September 27, 2012
Summary
Overlap among severe cutaneous adverse drug reactions (SCARs) like AGEP, DRESS, and SJS-TEN is rare, with only 2.1% of confirmed cases showing overlap. Early diagnosis of these drug reactions can be challenging due to overlapping symptoms.
Area of Science:
- Dermatology
- Pharmacology
- Clinical Medicine
Background:
- Severe cutaneous adverse reactions to drugs (SCARs) encompass conditions like acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), and Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS-TEN).
- The varied presentations of SCARs can complicate diagnosis, leading to potential overlap among these severe adverse drug reactions (ADRs).
- Overlapping SCARs are defined as cases meeting diagnostic criteria for at least two distinct SCARs.
Purpose of the Study:
- To determine the prevalence of overlapping SCARs in a French referral hospital setting.
- To assess the diagnostic challenges and potential overlap between AGEP, DRESS, and SJS-TEN.
Main Methods:
- Retrospective analysis of 216 patients hospitalized over seven years with diagnoses including AGEP, DRESS, SJS-TEN, or unspecified "drug rash."
- Application of RegiSCAR group diagnostic scoring systems to evaluate each case for AGEP, DRESS, and SJS-TEN based on clinical data and skin biopsies.
- Categorization of cases based on diagnostic certainty (definite, probable, or possible).
Main Results:
- Out of 216 analyzed cases, 45 (21%) presented with at least two possible diagnoses.
- A single predominant diagnosis was identified in 35 cases.
- Only 3 cases (2.1% of 145 confirmed SCARs) met the criteria for definite overlapping SCARs.
Conclusions:
- Confirmed cases of overlapping SCARs are infrequent, despite potential diagnostic ambiguities.
- Retrospective analysis using diagnostic algorithms can reliably differentiate between AGEP, DRESS, and SJS-TEN.
- Early identification of SCARs in the acute phase remains challenging due to overlapping clinical and biological features.
Related Concept Videos
01:30Drug Toxicity: Allergic Reactions
Drug-related allergies are immune-mediated responses triggered by the administration of pharmacological agents. These hypersensitivity reactions are classified based on the immune mechanisms involved. The four primary types—Type I, II, III, and IV—are mediated by different immunological pathways and exhibit distinct clinical manifestations.Type I Hypersensitivity/ IgE-Mediated Reactions: Immunoglobulin E (IgE) immediately mediates Type I hypersensitivity reactions. Upon initial exposure to a...
01:19Clinical Applications of Epidermal Stem Cells
Epidermal stem cells (EpiSCs) are mainly located at the basal layer of the epidermis. These cells repair minor injuries of the skin and replace dead skin cells. However, EpiSCs’ cannot heal severe wounds such as major burns or those from diabetes or hereditary disorders. In such cases, culturing the epidermal stem cells from the patient is possible and has yielded successful treatment options, such as laboratory-grown skin grafts. These grafts are synthesized using a patient’s own EpiSCs...
01:24Drug Toxicity: Dose-Dependent Reactions
Drug toxicities can be stratified into pharmacological, pathological, or genotoxic based on their mechanisms. The incidence and severity of these toxicities generally increase with the drug's concentration in the body and exposure time.Pharmacological toxicity is evident when the therapeutic effects of drugs overshoot into adverse reactions in a predictable, dose-dependent manner. Central nervous system (CNS) depression from barbiturates is a classic example, with effects escalating from...
01:26Toxic Reactions: Overview
When toxic substances penetrate the human body, they disseminate to various tissues, undergoing metabolic changes. This process yields reactive metabolites that may covalently bind with specific target molecules, resulting in toxicity.
Toxicity falls into two primary categories: local and systemic.
Local toxicity appears at the exposure site, such as protein denaturation caused by caustic substances.
In contrast, systemic toxicity requires the toxic agent's absorption and distribution,...
Toxicity falls into two primary categories: local and systemic.
Local toxicity appears at the exposure site, such as protein denaturation caused by caustic substances.
In contrast, systemic toxicity requires the toxic agent's absorption and distribution,...
01:24Drug Toxicity: Risk factors
Adverse Drug Reactions (ADRs) are potential complications that arise during pharmacotherapy, influenced by multiple risk factors. Age plays a significant role; both neonates and the elderly are at heightened risk due to their respective immature and diminished metabolic and elimination processes. Gender also impacts ADRs, with females experiencing a 1.5 to 1.7-fold greater risk than males, which may be linked to pharmacokinetic, pharmacodynamic, and hormonal differences. Notably, neonates, the...
01:00Drug Toxicity: Overview
Drug toxicity quantifies the harm a compound causes to an organism, varying by dose and potentially impacting whole systems or specific organs like the liver. Toxic reactions may arise from venomous insect or spider bites, with effects ranging from mild symptoms to severe outcomes such as brain damage or death. Common forms of acute poisoning include ethanol intoxication and overdose of pain or fever medications, with substances like GHB and heroin being particularly lethal at doses close to...