Systemic allergic dermatitis (systemic contact dermatitis) from pharmaceutical drugs: A review

Area of Science:

• Dermatology
• Allergology
• Pharmacology

Background:

• Systemic allergic dermatitis (SAD), also known as systemic contact dermatitis, is a rare but significant adverse drug reaction.
• Both topical and systemic drug administration routes can precipitate SAD.
• Understanding the causative agents and clinical presentations is crucial for diagnosis and management.

Purpose of the Study:

• To review the existing literature on systemic allergic dermatitis (SAD).
• To identify the drugs and routes of administration most frequently implicated in SAD.
• To describe the clinical manifestations and pathomechanisms of SAD.

Main Methods:

• Comprehensive literature review of studies reporting systemic allergic dermatitis.
• Analysis of identified culprit drugs, routes of exposure, and patient demographics.
• Categorization of clinical presentations and discussion of potential pathomechanisms.

Main Results:

• Topical drugs caused SAD in 95 patients, with budesonide, bufexamac, and dibucaine being common culprits.
• Systemic drugs caused SAD in 240 patients; mitomycin C, methylprednisolone, and hydrocortisone were frequently implicated.
• Corticosteroids accounted for 19% of culprit drugs, with nearly 40% of these reactions occurring during drug provocation tests.

Conclusions:

• Systemic allergic dermatitis is predominantly caused by systemic drugs, particularly corticosteroids.
• Drug provocation tests are a significant factor in SAD reactions.
• Further research into the pathophysiology of SAD is warranted to explain its rarity.