Cutaneous adverse drug reactions

Area of Science:

• Dermatology
• Pharmacology
• Immunology

Background:

• Cutaneous adverse drug reactions (ADRs) present diverse clinical patterns, often lacking specific indicators of drug causality.
• Maculopapular exanthema and urticaria are frequent, while severe reactions like Stevens-Johnson syndrome and DRESS necessitate rapid diagnosis.

Purpose of the Study:

• To outline the diagnostic approach for cutaneous ADRs.
• To highlight the importance of identifying serious cutaneous ADRs and reporting them to pharmacovigilance systems.

Main Methods:

• Clinical pattern recognition.
• Analysis of risk factors (immunosuppression, autoimmunity, genetic variants).
• Consideration of implicated drug classes (antibiotics, anticonvulsants, etc.) and pathophysiological mechanisms (immunologic, toxic).

Main Results:

• Common ADRs include maculopapular exanthema and urticaria.
• Serious ADRs (SJS, TEN, DRESS, AGEP) require urgent management.
• Allopurinol, antibiotics, anticonvulsants are frequently implicated.
• Allergic and toxic mechanisms contribute to ADRs.
• Allergological tests have variable sensitivity for confirming causality.
• No definitive in vivo or in vitro test exists for consistent causality confirmation.

Conclusions:

• A systematic approach combining clinical, chronological, and differential diagnostic factors is essential for identifying drug-induced rashes.
• Pharmacovigilance reporting is vital for individual patient management and population-level drug safety surveillance, especially for severe or novel drug reactions.