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Allergic cutaneous reactions to drugs
M Bigby1, R S Stern, K A Arndt
1Department of Dermatology, Charles A. Dana Research Institute, Beth Israel Hospital, Boston, Massachusetts.
Primary Care
|September 1, 1989
Summary
Drug eruptions, including exanthems and urticaria, are common adverse skin reactions to medications. Identifying and stopping the offending drug is key to treating these immune-mediated or other reactions.
Area of Science:
- Dermatology
- Immunology
- Pharmacology
Background:
- The exact cause of many drug eruptions remains unknown, often leading to diagnoses based on clinical presentation.
- Adverse cutaneous drug reactions are common, with drug exanthems and urticaria being the most frequent.
- Drug exanthems affect 2-3% of inpatients, frequently caused by antibiotics and blood products, with higher incidence in specific populations like AIDS patients on trimethoprim-sulfamethoxazole.
Purpose of the Study:
- To review the clinical features and common causes of various drug eruptions.
- To highlight the diagnostic and therapeutic considerations for adverse cutaneous drug reactions.
- To discuss less common but severe drug eruptions and their potential pathogenesis.
Main Methods:
- Review of clinical features of common and uncommon drug eruptions.
- Identification of frequently implicated drugs and patient populations.
- Discussion of pathogenetic mechanisms, including immune-mediated and photoallergic reactions.
Main Results:
- Drug exanthems, urticaria, and allergic contact dermatitis are the most common adverse cutaneous drug reactions.
- Urticaria lesions resolve within 24 hours without scarring and may not require systemic corticosteroids.
- Other eruptions like toxic epidermal necrolysis and erythema multiforme share similar features and pathogenesis.
Conclusions:
- Identifying and discontinuing the causative drug is crucial for managing drug eruptions.
- Understanding the clinical spectrum and potential mechanisms aids in diagnosis and treatment.
- Photoallergic reactions necessitate drug exposure, UV irradiation, and immune system interaction.