Cited by 60Drug-Induced Adverse ReactionsPharmacovigilance and Adverse Drug ReactionsContact Dermatitis and Allergies

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Current Perspectives on Severe Drug Eruption

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Zhang, Jingzhan, Lei, Zixian, Xu, Chen, Zhao, Juan, Kang, Xiaojing·2021·Clinical Reviews in Allergy & Immunology

DOI 10.1007/s12016-021-08859-0PMC PMC8286049

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Abstract

Adverse drug reactions involving the skin are commonly known as drug eruptions. Severe drug eruption may cause severe cutaneous adverse drug reactions (SCARs), which are considered to be fatal and life-threatening, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), acute generalized exanthematous pustulosis (AGEP), and drug reaction with eosinophilia and systemic symptoms (DRESS). Although cases are relatively rare, approximately 2% of hospitalized patients are affected by SCARs. There is an incidence of 2 to 7 cases/million per year of SJS/TEN and 1/1000 to 1/10,000 exposures to offending agents result in DRESS. However, the mortality rate of severe drug eruptions can reach up to 50%. SCARs represent a real medical emergency, and early identification and proper management are critical to survival. The common pathogenesis of severe drug eruptions includes genetic linkage with HLA- and non-HLA-genes, drug-specific T cell-mediated cytotoxicity, T cell receptor restriction, and cytotoxicity mechanisms. A multidisciplinary approach is required for acute management. Immediate withdrawal of potentially causative drugs and specific supportive treatment is of great importance. Immunoglobulins, systemic corticosteroids, and cyclosporine A are the most frequently used treatments for SCARs; additionally, new biologics and plasma exchange are reasonable strategies to reduce mortality. Although there are many treatment methods for severe drug eruption, controversies remain regarding the timing and dosage of drug eruption. Types, dosages, and indications of new biological agents, such as tumor necrosis factor antagonists, mepolizumab, and omalizumab, are still under exploration. This review summarizes the clinical characteristics, risk factors, pathogenesis, and treatment strategies of severe drug eruption to guide clinical management.

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See all 60

Authors: Zhang, J., Lei, Z., Xu, C., Zhao, J., & Kang, X.
Affiliations: People's Hospital of Xinjiang Uygur Autonomous Region (CN)
Corresponding author: Kang, Xiaojing
ORCID: Kang, Xiaojing
Venue: Clinical Reviews in Allergy & Immunology
Publisher: Springer Science and Business Media LLC
Published: 2021-07-17
Volume: 61
Issue: 3
Pages: 282-298
ISSN: 1080-0549 (ISSN-L)
1559-0267
DOI: 10.1007/s12016-021-08859-0
PMC: PMC8286049
OpenAlex: W3179474331
Cited by: 60
References: 157
Citations by year: 2026: 8 · 2025: 17 · 2024: 15 · 2023: 13 · 2022: 6 · 2021: 1
FWCI: 1.11
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springernature.com/gp/researchers/text-and-data-mining (tdm)
www.springernature.com/gp/researchers/text-and-data-mining (vor)
Locations: Clinical Reviews in Allergy & Immunology (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Pharmacology (medical) › Drug-Induced Adverse Reactions
Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
Health Sciences › Medicine › Dermatology › Contact Dermatitis and Allergies
Keywords: severe cutaneous adverse reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, clothing, HLA association, T cell cytotoxicity, drug withdrawal, corticosteroids, cyclosporine, plasma exchange, tumor necrosis factor inhibitors, mepolizumab, omalizumab
MeSH terms: Drug Eruptions, Humans, Risk Factors, Severity of Illness Index

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