Eczematous Drug Eruptions

Area of Science:

• Dermatology
• Pharmacology
• Immunology

Background:

• Eczematous drug eruptions present clinically and histologically like eczema.
• These reactions are triggered by systemically administered medications.
• Understanding the etiology is crucial for diagnosis and management.

Purpose of the Study:

• To review and catalog systemic medications causing eczematous drug eruptions.
• To identify the characteristic clinical presentations of these eruptions.
• To explore the underlying pathophysiologic mechanisms and emerging causes.

Main Methods:

• Comprehensive literature review of eczematous drug eruptions.
• Cataloging of causative medications and their clinical presentations.
• Analysis of pathophysiologic etiologies, including immunomodulation, dehydration, and hypersensitivity.

Main Results:

• Three primary pathophysiologic etiologies identified: cutaneous immunomodulation, skin dehydration, and delayed hypersensitivity.
• Increasing incidence noted with biologic therapies (TNF-α, IL-17 inhibitors) and targeted cancer treatments (ICIs, EGFR inhibitors).
• Other causes include antivirals (HCV) and cardiovascular drugs in the elderly; subtypes include systemic contact dermatitis and photoallergic reactions.

Conclusions:

• Eczematous drug eruptions are diverse, with rising prevalence due to novel therapeutics.
• Drug rechallenge is the diagnostic gold standard.
• Treatment typically involves emollients, topical corticosteroids, and oral antihistamines.