Skip to main content

Severe Cutaneous Adverse Reactions

  • Chapter
Braun-Falco’s Dermatology

Abstract

There are a variety of drug reactions that can be severe and life-threatening. Among these are Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Both are characterized by erythematous lesions, blisters, and mucosal involvement that together lead to a clinical picture resembling that of a severe burn. Together with erythema multiforme, SJS and TEN comprise a spectrum of severe blistering skin reactions. In the following, they are considered in detail, whereas other extensive cutaneous drug eruptions, including hypersensitivity syndrome, acute generalized exanthematous pustulosis, and erythroderma, are briefly discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Bibliography

  • Auquier-Dunant A, Mockenhaupt M, Naldi L et al (2002) Correlations between clinical patterns and causes of erythema multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Arch Dermatol 138:1019–1024

    Article  PubMed  Google Scholar 

  • Bachot N, Roujeau JC (2001) Physiopathology and treatment of severe drug eruptions. Curr Opin Allergy Clin Immunol 1:293–298

    CAS  PubMed  Google Scholar 

  • Bachot N, Revuz J, Roujeau JC (2003) Intravenous immunoglobulin treatment for Stevens-Johnson syndrome and toxic epidermal necrolysis. A prospective noncomparative study showing no benefit on mortality or progression. Arch Dermatol 139:33–36

    Article  CAS  PubMed  Google Scholar 

  • Bastuji-Garin S, Rzany B, Stern RS et al (1993) Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme. Arch Dermatol 129:92–96

    Article  CAS  PubMed  Google Scholar 

  • Bastuji-Garin S, Fouchard N, Bertocchi M et al (2000) SCORTEN: a severityof-illness score for toxic epidermal necrolysis. J Invest Dermatol 115: 149–153

    Article  CAS  PubMed  Google Scholar 

  • Bocquet H, Bagot M, Roujeau JC (1996) Drug-induced pseudolymphoma and drug hypersensitivity syndrome (Drug Rash with Eosinophilia and Systemic Symptoms: DRESS). Semin Cutan Med Surg 15:250–257

    Article  CAS  PubMed  Google Scholar 

  • Callot V, Roujeau JC, Bagot M et al (1996) Drug-induced pseudolymphoma and hypersensitivity syndrome. Two different clinical entities. Arch Dermatol 132:1315–1321

    Article  CAS  PubMed  Google Scholar 

  • Chung WH, Hung SI, Hong HS et al (2004) A marker for Stevens-Johnson syndrome. Nature 428:486

    Article  CAS  PubMed  Google Scholar 

  • Davidovici BB, Pavel D, Cagnano E et al (2006) Acute generalized exanthematous pustulosis following a spider bite: report of 3 cases. J Am Acad Dermatol 55:525–529

    Article  PubMed  Google Scholar 

  • Dietrich A, Kawakubo Y, Rzany B et al (1995) Low N-acetylating capacity in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. Exp Dermatol 4:313–316

    Article  CAS  PubMed  Google Scholar 

  • Elias PM, Fritsch P, Epstein EH Jr (1977) Staphylococcal scalded skin syndrome: clinical features, pathogenesis, and recent microbiological and biochemical developments. Arch Dermatol 113:207–219

    Article  CAS  PubMed  Google Scholar 

  • Fagot JP, Mockenhaupt M, Bouwes Bavinck JN et al (2001) Nevirapine and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis — preliminary results of a case-control study. AIDS 15:1–6

    Article  Google Scholar 

  • Garcia-Doval I, LeCleach L, Bocquet H et al (2000) Toxic epidermal necrolysis and Stevens-Johnson syndrome. Does early withdrawal of causative drugs decrease the risk of death? Arch Dermatol 136:323–327

    Article  CAS  PubMed  Google Scholar 

  • Guegan S, Bastuji-Garin S, Poszepczynska-Guigne E et al (2006) Performance of the SCORTEN during the first five days of hospitalization to predict the prognosis of epidermal necrolysis. J Invest Dermatol 126:272–276

    Article  CAS  PubMed  Google Scholar 

  • Halebian PH, Madden MR, Finklestein JL et al (1986) Improved burn center survival of patients with toxic epidermal necrolysis managed without corticosteroids. Ann Surg 204:503–512

    Article  CAS  PubMed  Google Scholar 

  • Halevy S, Ghislain PD, Mockenhaupt M et al (2008) Allopurinol is the most common cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel. J Am Acad Dermatol 58:25–32

    Article  PubMed  Google Scholar 

  • Hung SI, Chung WH, Liou LB et al (2005) HLA-B*5801 allele as a genetic marker for severe cutaneous adverse reactions caused by allopurinol. Proc Natl Acad Sci USA 102:4134–4139

    Article  CAS  PubMed  Google Scholar 

  • Kano Y, Hiraharas K, Sakuma K et al (2006) Several herpesviruses can reactivate in a severe drug-induced multiorgan reaction in the same sequential order as in graft-versus-host disease. Br J Dermatol 155:301–306

    Article  CAS  PubMed  Google Scholar 

  • Kardaun SH, Sidoroff A, Valeyrie-Allanore L et al (2007) Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms: does a DRESS syndrome really exist? Br J Dermatol 156:609–611

    Article  CAS  PubMed  Google Scholar 

  • Lonjou C, Borot N, Sekula P et al (2008) A European study of HLA-B in Stevens-Johnson syndrome and toxic epidermal necrolysis related to five high-risk drugs. Pharmacogenet Genomics 18:99–107

    Article  CAS  PubMed  Google Scholar 

  • Mockenhaupt M, Norgauer J (2002) Cutaneous adverse drug reactions: Stevens-Johnson syndrome and toxic epidermal necrolysis. Allergy & Clinical Immunology International 14:143–150

    Article  Google Scholar 

  • Mockenhaupt M, Messenheimer J, Tennis P et al (2005) Risk for Stevens-Johnson syndrome and toxic epidermal necrolysis in new users of antiepileptics. Neurology 64:1134–1138

    CAS  PubMed  Google Scholar 

  • Mockenhaupt M, Idzko M, Grosber M et al (2005) Epidemilogy of staphylococcal scalded skin syndrome in Germany. J Invest Dermatol 124:700–703

    Article  CAS  PubMed  Google Scholar 

  • Mockenhaupt M (2007) Schwere Arzneimittel-induzierte Hautreaktionen. CME Dermatol 2:4–18

    Google Scholar 

  • Mockenhaupt M, Viboud C, Dunant A et al (2008) Stevens-Johnson syndrome and toxic epidermal necrolysis: assessment of medication risks with emphasis on recently marketed drugs. The EuroSCAR-study. J Invest Dermatol 128:35–44

    Article  CAS  PubMed  Google Scholar 

  • Patrizi A, Savoia F, Giacomini F et al (2007) Diffuse acute pustular eruption after streptococcal infection—a new instance of pustulosis acuta generalisata. Pediatr Dermatol 24:272–276

    Article  PubMed  Google Scholar 

  • Paul C, Wolkenstein P, Adle H et al (1996) Apoptosis as a mechanism of keratinocyte death in toxic epidermal necrolysis. Br J Dermatol 134: 710–714

    Article  CAS  PubMed  Google Scholar 

  • Peyriere H, Dereure O, Breton H et al (2006) Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms: does a DRESS syndrome really exist? Br J Dermatol 155:422–428

    Article  CAS  PubMed  Google Scholar 

  • Prange B, Marini A, Kalke A et al (2005) Akute lokalisierte exanthematische Pustulose (ALEP). J Dtsch Dermatol Ges 3:210–212

    PubMed  Google Scholar 

  • Prins C, Kerdel FA, Padilla S et al (2003) Treatment of toxic epidermal necrolysis with high-dose intravenous immunoglobulins. Multicenter retrospective analysis of 48 consecutive cases. Arch Dermatol 139:26–32

    Article  CAS  PubMed  Google Scholar 

  • Revuz JE, Roujeau JC (1996) Advances in toxic epidermal necrolysis. Semin Cutan Med Surg 15:264

    Google Scholar 

  • Roujeau JC, Chosidow O, Saiag P et al (1990) Toxic epidermal necrolysis (Lyell’s syndrome). J Am Acad Dermatol 23:1052

    Article  Google Scholar 

  • Roujeau JC, Bioulac-Sage P, Bourseau C et al (1991) Acute generalized exanthematous pustulosis. Analysis of 63 cases. Arch Dermatol 127: 1333–1338

    Article  CAS  PubMed  Google Scholar 

  • Roujeau JC, Stern RS (1994) Severe adverse cutaneous reactions to drugs. New Eng J Med 331:1272–1285

    Article  CAS  PubMed  Google Scholar 

  • Roujeau JC, Kelly JP, Naldi L et al (1995) Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. N Engl J Med 333:1600–1607

    Article  CAS  PubMed  Google Scholar 

  • Rzany B, Hering O, Mockenhaupt M et al (1996) Histopathological and epidemiological characteristics of patients with erythema exsudativum multiforme majus (EEMM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Br J Dermatol 135:6–11

    Article  CAS  PubMed  Google Scholar 

  • Rzany B, Mockenhaupt M, Baur S et al (1996) Epidemiology of erythema exsudativum multiforme majus (EEMM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in Germany (1990-1992). Structure and results of a population-based registry. J Clin Epidemiol 49:769–773

    Article  CAS  PubMed  Google Scholar 

  • Schleinitz N, Veit V, Coso D et al (2005) Drug-induced eosinophilia and systemic symptoms: hypersensitivity or peripheral T-cell lymphoma? Arch Dermatol 141:395–396

    Article  PubMed  Google Scholar 

  • Schneck J, Fagot JP, Sekula P et al (2008) Effects of treatments on the mortality of Stevens-Johnson syndrome and toxic epidermal necrolysis: A retrospective study on patients included in the prospective EuroSCAR Study. J Am Acad Dermatol 58:33–40

    Article  PubMed  Google Scholar 

  • Schöpf E, Stühmer A, Rzany B et al (1991) Toxic epidermal necrolysis and Stevens-Johnson syndrome. An epidemiologic study from West-Germany. Arch Dermatol 127: 839–842

    Article  PubMed  Google Scholar 

  • Seishima A, Yamanaka S, Fujisawa T et al (2006) Reactivation of human herpesvirus (HHV) family members other than HHV-6 in drug-induced hypersensitivity syndrome. Br J Dermatol 155:344–349

    Article  CAS  PubMed  Google Scholar 

  • Sidoroff A, Halevy S, Bouwes Bavinck JN (2001) Acute generalized exanthematous pustulosis (AGEP) — a clinical reaction pattern. J Cutan Pathol 28:113–119

    Article  CAS  PubMed  Google Scholar 

  • Sidoroff A, Dunant A, Viboud C et al (2007) Risk factors for acute generalized exanthematous pustulosis (AGEP)-results of a multinational casecontrol study (EuroSCAR). Br J Dermatol 157:989–996

    Article  CAS  PubMed  Google Scholar 

  • Stern RS (2000) Improving the outcome of patients with toxic epidermal necrolysis and Stevens-Johnson syndrome. Arch Dermatol 136:410–411

    Article  CAS  PubMed  Google Scholar 

  • Sullivan JR, Shear NH (2001) The drug hypersensitivity syndrome: what is the pathogenesis? Arch Dermatol 137:357–364

    CAS  PubMed  Google Scholar 

  • Sun TT, Lavker RM (2004) Corneal epithelial stem cells: past, present, and future. J Invert Dermatol Symph Proc 9:204–207

    Google Scholar 

  • Trent JT, Kirsner RS, Romanelli P et al (2003) Analysis of intravenous immunoglobulin for the treatment of toxic epidermal necrolysis using SCORTEN. The University of Miami experience. Arch Dermatol 139: 39–43

    Article  CAS  PubMed  Google Scholar 

  • Viard I, Wehrli P, Bullani R et al (1998) Inhibition of toxic epidermal necrolysis by blockade of CD95 with human intravenous immunoglobulin. Science 282:490–493

    Article  CAS  PubMed  Google Scholar 

  • Wolff K, Tappeiner G (2003) Treatment of toxic epidermal necrolysis. The uncertainty persists but the fog is dispersing. Arch Dermatol 139: 85–86

    Article  PubMed  Google Scholar 

  • Wolkenstein P, Charue D, Laurent P et al (1995) Metabolic predisposition to cutaneous adverse drug reactions: role in toxic epidermal necrolysis caused by sulfonamides and anticonvulsants. Arch Dermatol 131: 544–551

    Article  CAS  PubMed  Google Scholar 

  • Wolkenstein P, Latarje J, Roujeau J et al (1998) Randomised comparison of thalidomide versus placebo in toxic epidermal necrolysis. Lancet 352: 1586–1589

    Article  CAS  PubMed  Google Scholar 

  • Ziemer M, Wiesend CL, Vetter R et al (2007) Cutaneous adverse drug reactions to valdecoxib distinct from Stevens-Johnson syndrome and toxic epidermal necrolysis. Arch Dermatol 143:711–716

    Article  CAS  PubMed  Google Scholar 

Classic Papers

  • Baker H, Ryan TJ (1968) Generalized pustular psoriasis. A clinical and epidemiological study of 104 cases. Br J Dermatol 80:771–793

    Article  CAS  PubMed  Google Scholar 

  • Beylot C, Bioulac P, Doutre MS (1980) Pustuloses exanthematiques aigues generalisees: a propos de 4 cas. Ann Dermatol Venereol 107:37–48

    CAS  PubMed  Google Scholar 

  • Coope R, Burrows RG (1940) Treatment of epilepsy with soidum diphenyl hydantoinate. Lancet I:490–492

    Article  Google Scholar 

  • Fuchs E (1876) Herpes oris conjunctivae. Klin Monatsbl Augenheilkd 14: 333–351

    Google Scholar 

  • Hebra von F (1866) Erythema exsudativum multiforme. In: Atlas der Hautkrankheiten. Kaiserliche Akademie der Wissenschaften, Wien, pp 54–57

    Google Scholar 

  • Lyell A (1956) Toxic epidermal necrolysis: an eruption resembling scalding of the skin. Br J Dermatol 68:355–361

    Article  CAS  PubMed  Google Scholar 

  • Saltzstein S, Ackerman L (1959) Lymphadenopathy induced by anticonvulsant drugs and mimicking clinically and pathologically malignant lymphoma. Cancer 12:164–182

    Article  CAS  PubMed  Google Scholar 

  • Stevens AM, Johnson FC (1922) A new eruptive fever associated with stomatitis and ophthalmia: report of two cases in children. Am J Dis Child 24:526–533

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer Medizin Verlag Heidelberg

About this chapter

Cite this chapter

Mockenhaupt, M. (2009). Severe Cutaneous Adverse Reactions. In: Burgdorf, W.H., Plewig, G., Wolff, H.H., Landthaler, M., Braun-Falco, O. (eds) Braun-Falco’s Dermatology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-29316-3_34

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-29316-3_34

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-29312-5

  • Online ISBN: 978-3-540-29316-3

Publish with us

Policies and ethics