High-risk drug rashes

Objective Provide a brief overview of the clinical presentation, common offending agents, management, prognosis, and mortality of selected six high-risk drug rashes, namely Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), multiple drug hypersensitivity syndrome (MDH), acute generalized exanthematous pustulosis (AGEP), and drug-induced bullous pemphigoid (DIBP). Data sources Review of published literature using PubMed, supplemented with authors' clinical experience. Study selections The most recent clinically relevant literature was chosen, as well as older seminal works. Results Most of the published data on these uncommon rashes was based on small observational series or case reports. SJS and TEN have specific genotypes association with certain drugs, have high morbidity and mortality, and require aggressive management by a team of multiple specialists. DRESS is a severe, prolonged multi-organ reaction, yet has a better prognosis than TEN. MDH is a syndrome of repeated reactions to unrelated drugs, often imposes diagnostic and management difficulties. AGEP consists of generalized sterile small pustules, usually mistaken for infection with subsequent inappropriate treatment. Bullous pemphigoid presents with tense pruritic bullae and characteristic linear basement membrane deposition of IgG and C3; DIBP has much better prognosis than the autoimmune variety. Conclusion In such high-risk drug rashes, early recognition, immediate withdrawal of the suspected drug(s), prompt individualized management, and monitoring vital organs function are mandatory for reducing morbidity and mortality. The lack of reliable tests for identification of the causative agent imposes difficulty, particularly in patients receiving multiple medications.