drug induced exfoliative dermatitis

Liver injury and exfoliative dermatitis caused by nifuratel[J]. Br J Dermatol. More than moderate, unresponsive to treatment, and which interferes with the Soldier's perfor-mance of duty. Article In postmarketing reports, cases of drug-induced hepatotoxicity have been reported in the first month, and in some cases, the first 2 months of therapy, but can occur at any time during treatment with diclofenac. Both DRESS and SJS may have increased liver enzymes and hepatitis, but they occur in only 10% of cases of SJS compared to 80% of DRESS. Fernando SL. Although the final result of this dual interaction is still under investigation, it seems that the combination of TNF-, IFN- (also present in TEN patients) and the activation of other death receptors such as TWEAK can lead to apoptosis of keratinocytes [44]. Arch Dermatol. Exfoliative dermatitis is a disease process in which most, and sometimes all, of the skin is involved in erythematous inflammation resulting in massive scaling.1 A variety of diseases and other exogenous factors may cause exfoliative dermatitis. Anti-tubercular therapy (ATT) induced exfoliative dermatitis-A case Prevalence is low, with mortality of roughly 512.5% for SJS and 50% for TEN [1, 2]. Granulysin is a key mediator for disseminated keratinocyte death in StevensJohnson syndrome and toxic epidermal necrolysis. In most severe cases the suggested dosage is iv 11.5mg/kg/day. Huff JC. Paquet P, et al. J Invest Dermatol. Erythema multiforme (EM), StevensJohnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Verma R, Vasudevan B, Pragasam V. Severe cutaneous adverse drug reactions. Fritsch PO. 2018 Jan 28;2018:9095275. doi: 10.1155/2018/9095275. Exfoliative Dermatitis - Medscape Inhibition of toxic epidermal necrolysis by blockade of CD95 with human intravenous immunoglobulin. J Allergy Clin Immunol. Role of nanocrystalline silver dressings in the management of toxic epidermal necrolysis (TEN) and TEN/StevensJohnson syndrome overlap. 1996;135(1):611. Lonjou C, et al. Man CB, et al. PubMed Drug-induced LPP. In particular, a specific T cell clonotype was present in the majority of patients with carbamazepine-induced SJS/TEN and that this clonotype was absent in all patients tolerant to the drug who shared the same HLA with the SJS/TEN patients [45]. What Is Exfoliative Dermatitis & How Does It Look? - SkinKraft Drug induced exfoliative dermatitis: state of the art of Internal Medicine, University of Bari, Bari, Italy, Andrea Nico,Elisabetta Di Leo,Paola Fantini&Eustachio Nettis, You can also search for this author in The SJS histology is characterized by a poor dermal inflammatory cell infiltrate and full thickness necrosis of epidermis [20, 49]. 2010;85(2):1318. Oral manifestations of erythema multiforme. Sekula P, et al. Gueudry J, et al. Exfoliative dermatitis is also a risk factor for epidemic spread of methicillin-resistant Staphylococcus aureus.6,20. Patients must be cleaned in the affected areas until epithelization starts. Descamps V, Ranger-Rogez S. DRESS syndrome. 2001;108(5):83946. 1997;22(3):1467. Anticoagulation therapy. 2008;23(5):54750. J Allergy Clin Immunol. The enhanced activation of CD8 T cells seems also to be influenced by the impaired function of CD4+CD25+FoxP3+Treg cells found in the peripheral blood of TEN patients in the acute phase [46]. J. Patients can be extremely suffering because of the pain induced by skin and mucosal detachment. The SCORTEN scale is based on a minimal set of parameters as described in the following table. 2004;114(5):120915. Epidemiological studies on EM, SJS and TEN syndromes report different results, probably related to several biases, such as ethnical differences, diagnostic criteria and drug consumption patterns in different socio-economic systems. (5.7, 8.1, 8.3) ADVERSE REACTIONS The most commonly reported adverse drug reactions (ADRs), reported in more than 20% of the patients and greater than placebo were skin reactions and diarrhea . Since cutaneous function as a multiprotective barrier is so disrupted in exfoliative dermatitis, the body loses heat, water, protein and electrolytes, and renders itself much more vulnerable to infection. The administration of a single dose of 5mg/kg was able to stop disease progression in 24h and to induce a complete remission in 614days. Article Arch Dermatol. Toxic epidermal necrolysis associated with severe cytomegalovirus infection in a patient on regular hemodialysis. A population-based study with particular reference to reactions caused by drugs among outpatients. HLA-B* 5801 allele as a genetic marker for severe cutaneous adverse reactions caused by allopurinol. Atypical target lesions manifest as raised, edematous, palpable lesions with only two zones of color change and/or an extensive exanthema with a poorly defined border darker in the center(Fig. Exfoliative Dermatitis Treatment & Management: Medical Care - Medscape Read this article to find out all its symptoms, causes and treatments. In EMM lesions typically begin on the extremities and sometimes spread to the trunk. Staphylococcal Scalded Skin Syndrome: criteria for Differential Diagnosis from Lyells Syndrome. StevensJohnson syndrome and toxic epidermal necrolysis: assessment of medication risks with emphasis on recently marketed drugs. J Dermatol. J Eur Acad Dermatol Venereol. 2002;146(4):7079. Clinical features; Delayed type hypersensitivity; Drug hypersensitivity; Erythema multiforme; Exfoliative dermatitis; Lyells syndrome; Pathogenesis; StevensJohnson syndrome; Therapy; Toxic epidermal necrolysis. In fact, it was demonstrated that the specificity of the TCR is a required condition for the self-reaction to occur. Fournier S, et al. Paradisi et al. 1). Drug-induced Exfoliative Dermatitis & Eosinophils Increased: Causes 2012;12(4):37682. Drug induced exfoliative dermatitis (ED) are a group of rare and severe drug hypersensitivity reactions (DHR) involving skin and usually occurring from days to several weeks after drug exposure. Bickle K, Roark TR, Hsu S. Autoimmune bullous dermatoses: a review. 2013;27(3):35664. Mortality rate of patients with TEN has shown to be directly correlated to SCORTEN. 585600. Unlike EMM, SJS and TEN are mainly related to medication use. Management of patients with a suspected drug induced exfoliative dermatitis Antibiotic therapy. 2008;4(4):22431. Plasmapheresis. Chapter 23. Exfoliative Dermatitis | Fitzpatrick's Dermatology in Dupixent DUPILUMAB 200 mg/1.14mL sanofi-aventis U.S. LLC Genotyping is recommended in specific high-risk ethnic groups (e.g. ADRJ,2015,17(6):464-465. Recurrent erythema multiforme: clinical characteristics, etiologic associations, and treatment in a series of 48 patients at Mayo Clinic, 2000 to 2007. 2013;69(2):1734. Patients with carcinoma of the colon, lung, prostate and thyroid have presented with erythroderma. Immunoregulatory effector cells in drug-induced toxic epidermal necrolysis. Careers. J Allergy Clin Immunol. Erythema multiforme StevensJohnson syndrome and toxic epidermal necrolysis. It is not recommended to use prophylactic antibiotic therapy. Adverse Drug Reactions: Types and Treatment Options | AAFP Exfoliative dermatitis, also known as erythroderma, is an uncommon but serious skin disorder that family physicians must be able to recognize and treat appropriately. 2018 Feb;54(1):147-176. doi: 10.1007/s12016-017-8654-z. If necessary, it can be repeated every 68h. NSAIDs should be avoided as they can induce ED as well. Perforin/granzyme B pathway: Nassif and colleagues have proposed a role for perforin/grazyme B in keratinocyte death [37]. Nayak S, Acharjya B. Int J Mol Sci. 1983;8(6):76375. A marked increase in serum soluble Fas ligand in drug-induced hypersensitivity syndrome. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Posadas SJ, et al. To confirm ATT induced erythroderma and narrow down the offending agents, sequential rechallenge with ATT was done and again these patients had similar lesions erupt all over the body only with isoniazid and pyrazinamide. Unable to load your collection due to an error, Unable to load your delegates due to an error, Erythema multiforme (photo reproduced with permission of Gary White, MD): typical target lesions (, Mortality rate of patients with TEN has shown to be directly correlated to SCORTEN. Hence, the apparent increase in cases of exfoliative dermatitis may be related to the introduction of many new drugs. 2022 May;35(5):e15416. Adverse cutaneous drug reaction. Am J Clin Dermatol. Grosber M, et al. A useful sign for differential diagnosis is the absence of mucosal involvement, except for conjunctiva. Download Free PDF. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Focus on the Pathophysiological and Diagnostic Role of Viruses. Do this 2 to 3 times a week. 2008;49(12):208791. Karnes JH, Miller MA, White KD, Konvinse KC, Pavlos RK, Redwood AJ, Peter JG, Lehloenya R, Mallal SA, Phillips EJ. Part of Apoptosis as a mechanism of keratinocyte death in toxic epidermal necrolysis. A patch testing and cross-sensitivity study of carbamazepine-induced severe cutaneous adverse drug reactions. Combination of infliximab and high-dose intravenous immunoglobulin for toxic epidermal necrolysis: successful treatment of an elderly patient. Bourgeois GP, et al. Talk to our Chatbot to narrow down your search. J Invest Dermatol. In SJS, SJS/TEN and TEN the efficacy of corticosteroids is far from being demonstrated. Sokumbi O, Wetter DA. CAS Australas J Dermatol. Rzany B, et al. Tohyama M, Hashimoto K. Immunological mechanisms of epidermal damage in toxic epidermal necrolysis. Chung and colleagues found an high expression of this molecule in TEN blister fluid [39] and confirmed both in vitro and in vivo its dose-dependent cytotoxicity [39]. . Polak ME, et al. Early sites of skin involvement include trunk, face, palms and soles and rapidly spread to cover a variable extension of the body. exfoliative dermatitis. tion in models of the types of systemic disease for S. aureus pathogenesis research is also expected to receive which anti-virulence drugs would be most desirable. Partial to full thickness epidermal necrosis, intraepidermal vesiculation or subepidermal blisters, due to spongiosis and to the cellular damage of the basal layer of the epidermis, can be present in the advanced disease [49] Occasionally, severe papillary edema is also present [20]. Mayo Clin Proc. Google Scholar. The type of rash that happens depends on the medicine causing it and your response. CAS Students also viewed Nostra aetate - Summary Theology: the basics Principles of Risk Management and Insurance Chapters 1-4 2004;428(6982):486. . The EuroSCAR-study. Clipboard, Search History, and several other advanced features are temporarily unavailable. Gout and its comorbidities: implications for therapy. Schopf E, et al. Wikizero - Basal-cell carcinoma J Am Acad Dermatol. 2012;66(6):e22936. Ramirez GA, Yacoub MR, Ripa M, Mannina D, Cariddi A, Saporiti N, Ciceri F, Castagna A, Colombo G, Dagna L. Biomed Res Int. PubMed Central 2008;52(3):1519. CAS Not responsive to therapy. J Invest Dermatol. 1). 8600 Rockville Pike Ethambutol Induced Exfoliative Dermatitis. Ann Intern Med. J Am Acad Dermatol. It could also be useful to use artificial tears and lubricating antiseptic gels. Blood counts and bone marrow studies may reveal an underlying leukemia. It is important to protect the damaged skin with sterile fat dressing especially in the genital area. Roujeau JC, Stern RS. Next vol/issue A serious cutaneous adverse drug reaction namely exfoliative dermatitis (erythroderma) is associated with isoniazid use . MalaCards based summary: Exfoliative Dermatitis is related to holocarboxylase synthetase deficiency and dermatitis, and has symptoms including exanthema An important gene associated with Exfoliative Dermatitis is SPINK5 (Serine Peptidase Inhibitor Kazal Type 5). Please enable it to take advantage of the complete set of features! All Rights Reserved. The induction dosage in EMM is usually 1mg/kg/day that should be maintained until a complete control of the skin is obtained. The velocity of infusion should be regulated according to patients arterial pressure with the aim of 30mL/h urinary output (1mL/kg/h in case of a child). Skin testing and patch testing in non-IgE-mediated drug allergy. Gastric protection. Guidelines for the management of drug-induced liver injury[J]. Efficacy of plasmapheresis for the treatment of severe toxic epidermal necrolysis: is cytokine expression analysis useful in predicting its therapeutic efficacy? Br J Clin Pharmacol. Even though exfoliative dermatitis is a complex disorder involving many factors, the underlying disease is usually the key determinant of the course and prognosis. N.Z. Exfoliative dermatitis may happen as a complication of other skin issues. Even patients with clear histories of preexisting dermatoses tend to have biopsies that are not diagnostic when they present with erythroderma.2, Laboratory evaluation of patients with erythroderma is generally not very helpful in determining a specific diagnosis. Google Scholar. Roujeau JC, et al. 1992;11(3):20710. 1996;134(4):7104. Khalil I, et al. Death ligand TRAIL, secreted by CD1a+and CD14+cells in blister fluids, is involved in killing keratinocytes in toxic epidermal necrolysis. In: Eisen AZ, Wolff K, editors. J Am Acad Dermatol. Stamp LK, Chapman PT. Fritsch PO. Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist. The approach to treatment should include discontinuation of any potentially causative medications and a search for any underlying malignancy. Half-life of the drug is approximately 54 h. Modification of nitisinone in liver and renal dysfunction is yet to be studied. Pathogenicity and Virulence of Staphylococcus Aureus | PDF Exfoliative dermatitis, also known as erythroderma, is an uncommon but serious skin disorder that family physicians must be able to recognize and treat appropriately. . 2007;56(5 Suppl):S1189. AR 40-501 14 June 2017 33 e. Dermatitis herpetiformis. Stevens-Johnson syndrome and toxic epidermal necrolysis due to anticonvulsants share certain clinical and laboratory features with drug-induced hypersensitivity syndrome, despite differences in cutaneous presentations. Correspondence to In HIV patients, the risk of SJS and TEN have been reported to be thousand-fold higher, roughly 1 per 1000 per year [19]. 2005;94(4):41923. A case of anti-BP230 antibody-positive dyshidrosiform bullous pemphigoid secondary to dipeptidyl peptidase-4 inhibitor in a 65-year-old Filipino female Joint Bone Spine. Erythroderma - Wikipedia Overall, incidence of SJS/TEN ranges from 2 to 7 cases per million person per year [9, 1820], with SJS the commonest [21]. 2014;70(3):53948. It is important to take into consideration the mechanism of action of the different drugs in the pathogenesis of ED [104]. Their occurrence can be prevented by avoiding drug over-prescription and drug associations that interfere with the metabolism of the most frequent triggers [118]. doi: 10.4065/mcp.2009.0379. Exfoliative Dermatitis: Symptoms, Diagnosis & Treatments - Healthline Br J Dermatol. Huff JC, Weston WL, Tonnesen MG. Erythema multiforme: a critical review of characteristics, diagnostic criteria, and causes. PubMed Central Erythroderma in adults - UpToDate 2013;133(5):1197204. Mayes T, et al. EM is a self-limited skin condition mainly associated with infections and drugs [53, 54]. Poor relevance of a lymphocyte proliferation assay in lamotrigine-induced StevensJohnson syndrome or toxic epidermal necrolysis. Samim F, et al. d. Cysts and tumors. Ko TM, et al. In more severe cases continuous iv therapy can be necessary. Toxic epidermal necrolysis: Part II Prognosis, sequelae, diagnosis, differential diagnosis, prevention, and treatment. A promising and complementary in vitro tool has been used by Polak ME et al. Google Scholar. Antitumour necrosis factor-alpha antibodies (infliximab) in the treatment of a patient with toxic epidermal necrolysis. DailyMed - DICLOFENAC SODIUM- diclofenac sodium solution Drug specific cytotoxic T-cells in the skin lesions of a patient with toxic epidermal necrolysis. Robyn A. McMenamin, L M. Davies and P. W. Craswell, Aust. 2010;37(10):9046. After 24 hours, split formation was evident in hematoxylin and eosin-stained sections of HOSCs treated . Chung WH, Hung SI. Lin YT, et al. Here we provide a systematic review on frequency, risk factors, pathogenesis, clinical features and management of patients with drug induced ED. ), Phenolphthalein (Agoral, Alophen, Modane), Rifampin (Rifadin, Rimactane; also in Rifamate), Trimethoprim (Trimpex; also in Bactrim, Septra). The incidence of erythema multiforme, StevensJohnson syndrome, and toxic epidermal necrolysis. Painkiller therapy. Paraneoplastic pemphigus is associated with neoplasms, most commonly of lymphoid tissue, but also Waldenstrms macroglobulinemia, sarcomas, thymomas and Castlemans disease. Exfoliative Dermatitis to Anti Tubercular Drugs - Academia.edu Drug induced exfoliative dermatitis (ED) are a group of rare and severe drug hypersensitivity reactions (DHR) involving skin and usually occurring from days to several weeks after drug exposure. Wetter DA, Camilleri MJ. J Invest Dermatol. Incidence of hypersensitivity skin reactions. Medical search. Frequent Springer Nature. HLA DQB1* 0301 allele is involved in the susceptibility to erythema multiforme. Rarely, Mycoplasma pneumoniae, dengue virus, cytomegalovirus, and contrast media may be the causative agent of SJS and TEN [22, 6567]. De Araujo E, et al. These levels could reflect the interaction between culprit drugs and aldehyde dehydrogenase that is the enzyme which metabolizes retinoid acid. Clinicians using antivirals for mpox should be alert for drug-drug interactions with any antiretrovirals used to prevent 16, 17 or treat 18 HIV infection as well as with any other medications used to prevent or treat HIV-related opportunistic infections. Qilu Pharmaceutical Co., Ltd. GEFITINIB- gefitinib tablet, coated 1990;126(1):3742. Aminoglutethimide: Aminoglutethimide may lead to a loss of corticosteroid-induced adrenal suppression. The lymphocyte transformation test in the diagnosis of drug hypersensitivity. It recommended to used G-CSF in patients with febrile neutropenia [94, 95]. Systemic derangements may occur with exfoliative. The dermis shows an inflammatory infiltrate characterized by a high-density lichenoid infiltrate rich in T cells (CD4+ more than CD8+) with macrophages, few neutrophils and occasional eosinophils; the latter especially seen in cases of DHR [5, 50]. (adult rickets), anticonvulsant-induced rickets and osteomalacia, osteoporosis, renal osteodystrophy . Rifampin, paracetamol, metronidazole, paclitaxel, erythromycin, and ibuprofen have all been reported to cause bullous FDE. Analysis of StevensJohnson syndrome and toxic epidermal necrolysis using the Japanese Adverse Drug Event Report database. Diagnosis in a routine setting is based on patch test (PT) while skin test (prick and intradermal tests) with a delayed reading are contraindicated in these patients [72]. Drug induced exfoliative dermatitis: State of the art - ResearchGate Options include use of PUVA light therapy, total-body electron beam irradiation, topical nitrogen mustard, systemic chemotherapy and extracorporeal photopheresis. Chan HL, et al. J Am Acad Dermatol. It is also extremely important to obtain within the first 24h cultural samples from skin together with blood, urine, nasal, pharyngeal and bronchus cultures. For SJS/TEN, corticosteroids are the cornerstone of treatment albeit efficacy remains unclear. Mittmann N, et al. The exact source of FasL production has not been yet identified as different groups have postulated that the production might be sought in keratinocytes themselves [33] or in peripheral blood mononuclear cells [34]. ALDEN, an algorithm for assessment of drug causality in StevensJohnson Syndrome and toxic epidermal necrolysis: comparison with case-control analysis. This has been called the nose sign.18, Once the erythema is well established, scaling inevitably follows (Figure 1). Autologous transplantation of mesenchymal umbilical cord cells seems also to be highly efficacious [102]. 1984;101(1):4850. official website and that any information you provide is encrypted Usually the amount of calories is 15002000kcal/day and the velocity of infusion is gradually increased based on patients tolerability [92]. Antiviral therapy. Also, physicians should be vigilant about possible secondary infection, whether cutaneous, pulmonary or systemic. Growth-factors (G-CSF). Br J Dermatol. Blood gas analysis, glucose and creatinine levels together with electrolytes should be evaluated and therapy should be modified accordingly. Retrospective review of StevensJohnson syndrome/toxic epidermal necrolysis treatment comparing intravenous immunoglobulin with cyclosporine. Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Delayed reactions to drugs show levels of perforin, granzyme B, and Fas-L to be related to disease severity. Drug-induced erythroderma invariably recovers completely with prompt initial management and removal of the offending drug. ABRIGO_Worksheet #8 Drug Study_Endocrine System.pdf Carbamazepine and phenytoin induced StevensJohnson syndrome is associated with HLA-B* 1502 allele in Thai population. Generalized exfoliative dermatitis, or erythroderma, is a severe inflammation of the entire skin surface. A rare case of toxic epidermal necrolysis with unexpected Fever resulting from dengue virus. Volume 8, Issue 1 Pages 1-90 (August 1994). Erythema multiforme (EM), Stevens- Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Grieb G, et al. 2, and described below. doi: 10.1111/dth.15416. 2013;69(4):37583. It should be used only in case of a documented positivity of cultural samples. Ann Burns Fire. The cutaneous T-cell lymphomas are the lymphomas most commonly associated with exfoliative dermatitis. Since the earliest descriptions of exfoliative dermatitis, medications have been known to be important causative agents. Exfoliative dermatitis (ED) is defined as diffuse erythema and scaling of the skin involving more than 90% of the total body skin surface area. In an open trial on cyclosporine in 29 patients with TEN, the use of Cys A for at least 10days led to a rapid improvement without infective complications [112]. Keywords: Epub 2022 Mar 9. They usually have fever, are dyspneic and cannot physiologically feed. The syndrome has been described previously in association with phenindione administration, leptospirosis and heavy metal poisoning. Exposure to anticonvulsivants (phenytoin, phenobarbital, lamotrigine), non-nucleoside reverse transcriptase inhibitors (nevirapine), cotrimoxazole and other sulfa drugs (sulfasalazine), allopurinol and oxicam NSAIDs [2] confers a higher risk of developing SJS/TEN. A significant number of these patients eventually progress to cutaneous T-cell lymphoma.8, Clinically, the first stage of exfoliative dermatitis is erythema, often beginning as single or multiple pruritic patches, involving especially the head, trunk and genital region. statement and A case of toxic epidermal necrolysis with involvement of the GI tract after systemic contrast agent application at cardiac catheterization. Open trial of ciclosporin treatment for StevensJohnson syndrome and toxic epidermal necrolysis. 2011;71(5):67283. Australas J Dermatol. 2011;20(5):103441. Erythema multiforme StevensJohnson syndrome and toxic epidermal necrolysis. Article Exfoliative dermatitis, including Stevens-Johnson syndrome, drug rash with eosinophilia and systemic symptoms, and toxic epidermal necrolysis, has occurred with anti-PD-1/PD-L1 treatments. Effects of treatments on the mortality of StevensJohnson syndrome and toxic epidermal necrolysis: a retrospective study on patients included in the prospective EuroSCAR Study. 2012;2012:915314. Drugs such as paracetamol, other non-oxicam NSAIDs and furosemide, bringing a relatively low risk of SJS/TEN a priori, are also highly prevalent as putative culprit agents in large SJS/TEN registries, due to their widespread use in the general population [63, 64] (Table1). 2007;62(12):143944. In patients who develop complications (i.e., infection, fluid and electrolyte abnormalities, cardiac failure), the rate of mortality is often high. Eur J Clin Microbiol Infect Dis. Given the different histopathological features of the EM, SJS and TEN, we decided to discuss them separately. For these reasons, patients should be admitted to intensive burn care units or in semi-intensive care units where they may have access to sterile rooms and to dedicated medical personnel [49, 88]. Bastuji-Garin S, et al. Sassolas B, et al. J Am Acad Dermatol. 2012;27(4):21520. Infectious agents are the major cause of EM, in around 90% of cases, especially for EM minor and in children. Drug induced interstitial nephritis, hepatitis and exfoliative dermatitis Consultation with an oncologist who is well-versed in treatment of cutaneous T-cell lymphoma is advisable once the disease progresses to the tumor stage. Schwartz RA et al. In EM a lymphocytic infiltrate (CD8+ and macrophages), associated with vacuolar changes and dyskeratosis of basal keratinocytes, is found along the dermo-epidermal junction, while there is a moderate lymphocytic infiltrate around the superficial vascular plexus [20]. Exanthematous drug eruptions. Drug induced exfoliative dermatitis (ED) are a group of rare and severe drug hypersensitivity reactions (DHR) involving skin and usually occurring from days to several weeks after drug exposure. Drugs.com provides accurate and independent information on more than . 1997;19(2):12732. c. Amyloidosis. Erythema multiforme: a review of epidemiology, pathogenesis, clinical features, and treatment. Nature. An extremely rare mucocutaneous adverse reaction following COVID-19 vaccination: Toxic epidermal necrolysis. Patients should be educated to avoid any causative drugs. 1991;127(6):83942. Br J Dermatol. Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. A catabolic state thus ensues, which is often responsible for significant weight loss.

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