drug induced exfoliative dermatitis

2016;2:14. Joint Bone Spine. J Dermatol Sci. 2010;37(10):9046. Even though exfoliative dermatitis is a complex disorder involving many factors, the underlying disease is usually the key determinant of the course and prognosis. EDs are serious and potentially fatal conditions. 2007;56(5 Suppl):S1189. Theoretically, any drug can trigger a reaction, but the medications most associated with this disorder are: Allopurinol; Antiepileptic medications; Barbiturates Li X, et al. Genotyping is recommended in specific high-risk ethnic groups (e.g. TEN is characterized by full-thickness epidermal necrosis with an evident epidermal detachment and sloughing caused by necrosis of keratinocytes following apoptosis [49, 52]. 2008;23(5):54750. Granulysin is a key mediator for disseminated keratinocyte death in StevensJohnson syndrome and toxic epidermal necrolysis. Erythema multiforme and toxic epidermal necrolysis: a comparative study. 2013;69(2):187. 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. IBUPROFENE ZENTIVA is indicated for the symptomatic treatment of headaches, migraines, dental pain, back pain, dysmenorrhea, muscle pain, neuralgia . In acute phase it is crucial to assess the culprit agent, in particular when the patient was assuming several drugs at time of DHR. Provided by the Springer Nature SharedIt content-sharing initiative. Antiepileptic medications, antihypertensive medications, antibiotics, calcium channel blockers and a variety of topical agents (Table 2)2,3,69 can cause exfoliative dermatitis, but theoretically, any drug may cause exfoliative dermatitis. Moreover, after granulysin depletion, they observed an increase in cell viability. Hypersensitivity, Delayed Drug Hypersensitivity Radiodermatitis Drug Eruptions Skin Diseases Hypersensitivity Hand-Foot Syndrome Hypersensitivity, Immediate Dermatitis, Contact Erythema Foot Dermatoses Hand Dermatoses Skin Neoplasms Dermatitis, Allergic Contact Alveolitis, Extrinsic Allergic Acneiform Eruptions Dentin Sensitivity Dermatitis The most common causes of death in patients with exfoliative dermatitis are pneumonia, septicemia and heart failure. Drug induced exfoliative dermatitis: state of the art. - Abstract Toxic epidermal necrolysis associated with severe cytomegalovirus infection in a patient on regular hemodialysis. Nutritional support. J Dermatol. The cutaneous T-cell lymphomas are the lymphomas most commonly associated with exfoliative dermatitis. Curr Opin Allergy Clin Immunol. 19 Key critical interactions are discussed below for each mpox antiviral. Patients with carcinoma of the colon, lung, prostate and thyroid have presented with erythroderma. 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. doi: 10.1016/j.jaad.2013.05.003. Defective regulatory T cells in patients with severe drug eruptions: timing of the dysfunction is associated with the pathological phenotype and outcome. The time interval between the appearance of exfoliative dermatitis and the appearance of cutaneous T-cell lymphoma lesions can vary from months to years or even decades. Paquet P, Pierard GE. A promising and complementary in vitro tool has been used by Polak ME et al. 2012;43:10115. Hydration and hemodynamic balance. Erythema multiforme and toxic epidermal necrolysis. These highlights do not include all the information needed to use Liver injury and exfoliative dermatitis caused by nifuratel[J]. In serious cases invasive ventilation can be necessary for ARDS. Management of patients with a suspected drug induced exfoliative dermatitis . Exfoliative dermatitis, also known as erythroderma, is an uncommon but serious skin disorder that family physicians must be able to recognize and treat appropriately. Given the different histopathological features of the EM, SJS and TEN, we decided to discuss them separately. 1998;37(7):5203. Severe Cutaneous Adverse Reactions: The Pharmacogenomics from Research to Clinical Implementation. These highlights do not include all the information needed to use Umbilical cord mesenchymal stem cell transplantation in drug-induced StevensJohnson syndrome. Add 1 cup (about 236 milliliters) of vinegar to a bathtub filled with warm water. Barbaud A, et al. Therefore, it is important to identify and treat any underlying disease whenever possible and to remove any contributing external factors.2, Most published studies of exfoliative dermatitis have been retrospective and thus do not address the issue of overall incidence. Drugs causing erythroderma | DermNet 1984;101(1):4850. However, according to a consensus definition [54], EMM syndrome has been separated from SJS/TEN spectrum. 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]. Qilu Pharmaceutical Co., Ltd. GEFITINIB- gefitinib tablet, coated 2010;31(1):1004. For the calculation, available values on vital and laboratory parameters within the first 3days after admission to the first hospital are considered when the reaction started outside the hospital (community patients) or at the date of hospitalization for in-hospital patients. Med Sci Monit. The most common causes of exfoliative dermatitis are preexisting dermatoses, drug reactions, malignancies and other miscellaneous or idiopathic disorders. government site. PubMed Central oboda J, Dudzik A, Chomyszyn-Gajewska M. Ramirez GA, Ripa M, Burastero S, Benanti G, Bagnasco D, Nannipieri S, Monardo R, Ponta G, Asperti C, Cilona MB, Castagna A, Dagna L, Yacoub MR. Microorganisms. In patients with this disorder, the mitotic rate and the absolute number of germinative skin cells are higher than normal. Furosemide or ethacrynic acid may be required to maintain an adequate urinary output [90]. Annu Rev Pharmacol Toxicol. Schwartz RA, McDonough PH, Lee BW. The management of toxic epidermal necrolysis. Drug induced exfoliative dermatitis - yxw_88 - | 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]. Oliveira L, Zucoloto S. Erythema multiforme minor: a revision. Dermatologist and/or allergist should confirm the diagnosis, individuate the culprit agent, give indications about skin management and necessity to obtain theconsultationofthe ENT specialist, the gynecologist/urologist, the ophthalmologist and/or the pulmonologist in the case of mucosal involvement. 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. The lesions consist of pruritic, annular papules, vesicles, and bullae that are found in groups, clinically it is similar to dermatitis herpetiformis, without a gluten-sensitive enteropathy [85]. In this study, 965 patients were reviewed. The action of antithyroid drugs may be delayed in amiodarone-induced thyrotoxicosis because of substantial quantities of preformed thyroid hormones stored in the gland. Keywords: UpToDate One of the most common malignancies associated with exfoliative dermatitis is cutaneous T-cell lymphoma, which may not manifest for months or even years after the onset of the skin condition. Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Tang YH, et al. Gastrointestinal: pancreatitis, glossitis, dyspepsia. Downey A, et al. Exfoliative Dermatitis to Anti Tubercular Drugs - Academia.edu HLA DQB1* 0301 allele is involved in the susceptibility to erythema multiforme. 2011;128(6):126676. Other dermatoses associated with erythroderma are listed in Table 1.2,3,68. J Am Acad Dermatol. 2, and described below. Federal government websites often end in .gov or .mil. Bullous dermatoses can be debilitating and possibly fatal. Pehr K. The EuroSCAR study: cannot agree with the conclusions. J Invest Dermatol. 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. 2011;38(3):23645. Del Pozzo-Magana BR, et al. New York: McGraw-Hill; 2003. pp. Once ED has occurred, it has to be managed in the adequate setting with a multidisciplinary approach, and every effort has to be made to identify and avoid the trigger and to prevent infectious and non-infectious complications. These studies have confirmed an association between carbamazepine-induced SJS/TEN with HLA-B*1502 allele among Han Chinese [27], carbamazepine and HLA-A*3101 and HLA-B*1511 [16], phenytoin and HLA-B*1502 [28], allopurinol and HLA-B*5801 [29]. All Rights Reserved. More recently, carcinomas of the fallopian tube,12 larynx13 and esophagus14 have been reported as causes of exfoliative dermatitis. In the acute phase, before determination of the etiology, treatment consists of measures to soothe the inflamed skin. N.Z. J Invest Dermatol. T and NK lymphocytes can produce FasL that eventually binds to target cells. Erythroderma See more images of erythroderma. Drug induced interstitial nephritis, hepatitis and exfoliative dermatitis Rabelink NM, Brakman M, Maartense E, Bril H, Bakker-Wensveen CA, Bavinck JN. In more severe cases corneal protective lens can be used. Part of ALDEN, an algorithm for assessment of drug causality in StevensJohnson Syndrome and toxic epidermal necrolysis: comparison with case-control analysis. In addition to all these mechanisms, alarmins, endogenous molecules released after cell damage, were found to be transiently increased in SJS/TEN patients, perhaps amplifying the immune response, including -defensin, S100A and HMGB1 [47]. These highlights do not include all the information needed to use Accessibility Allergol Immunopathol (Madr). During the acute reaction, diagnosis of ED is mainly based on clinical parameters. J Invest Dermatol. [49] confirmed these results and even suggested that higher dosage regimen with 2.74g/kg seem to be more effective in survival outcome. N Engl J Med. Epilepsia. Huff JC. 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). The SCORTEN scale is based on a minimal set of parameters as described in the following table. Ann Pharmacother. 2013;69(4):37583. 583-587. Skin testing and patch testing in non-IgE-mediated drug allergy. Kostal M, et al. Toxic epidermal necrolysis (Lyell syndrome). It should be considered only once the patient is stable and if the skin damage is still ongoing and doesnt respond to other conventional therapies (corticosteroids or IVIG). Sekula P, et al. Rare dermatological side effects such as alopecia, exfoliative dermatitis, xeroderma, pruritus have been reported. A pseudolymphoma reaction with fever, arthralgias, lymphadenopathy, hepatosplenomegaly, anemia and erythroderma may develop as a result of hypersensitivity to dapsone or antiepileptic drugs. 2011;3(1):e2011004. CAS Int J Dermatol. The fluid of blisters from TEN patients was found to be rich in TNF-, produced by monocytes/macrophages present in the epidermis [42], especially the subpopulation expressing CD16, known to produce higher levels of inflammatory cytokines [43]. Oral hygiene with antiseptic and painkiller mouthwash (chlorhexidine+lidocaine+aluminum hydroxide) together with aerosol therapy with saline and bronchodilators can reduce upper airways symptoms. [71] realized an algorhitm named ALDEN (algorithm of drug causality for epidermal necrolysis) which helps to establish a cause/effect relationship as probable or very probable in 70% of cases. Skin manifestations of drug allergy. Am Fam Physician. In more severe cases antiviral therapies should be given together with intravenous immunoglobulins [93]. Download Free PDF. Targeting keratinocyte apoptosis in the treatment of atopic dermatitis and allergic contact dermatitis. eCollection 2018. Pathogenicity and Virulence of Staphylococcus Aureus | PDF Paul C, et al. A classic example of an idiosyncratic reaction is drug-induced . PubMed 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. 2013;69(2):173174. 2002;146(4):7079. Gonzalez-Delgado P, et al. 2009;29(3):51735. New York: McGraw-Hill; 2003. pp. Patients must be cleaned in the affected areas until epithelization starts. b. Atopic dermatitis. In case of a respiratory failure, oxygen should be administrated and a NIMV may be required. It could also be useful to use artificial tears and lubricating antiseptic gels. 2015;56(4):298302. . Australas J Dermatol. Erythroderma | DermNet Genome-scale investigation of drug-induced termination codon-readthrough in a model system of epidermolysis bullosa . Toxic epidermal necrolysis and StevensJohnson syndrome. Privacy Pemphigus vulgaris, paraneoplastic pemphigus, bullous pemphigoid and linear IgA dermatosis have to be considered. Perforin/granzyme B pathway: Nassif and colleagues have proposed a role for perforin/grazyme B in keratinocyte death [37]. SCORTEN: a severity-of-illness score for toxic epidermal necrolysis. asiatic) before starting therapies with possible triggers (e.g. The serum levels of granulysin were also found to be increased in the early stage of SJS/TEN, but not in other cutaneous DHR [40]. FDA Drug information Palynziq Read time: 10 mins Marketing start date: 04 Mar 2023 . All authors read and approved the final manuscript. A catabolic state thus ensues, which is often responsible for significant weight loss. Toxic epidermal necrolysis treated with cyclosporin and granulocyte colony stimulating factor. J Am Acad Dermatol. Mayo Clin Proc. Autologous transplantation of mesenchymal umbilical cord cells seems also to be highly efficacious [102]. StevensJohnson syndrome and toxic epidermal necrolysis: a review of the literature. 2014;70(3):53948. Open trial of ciclosporin treatment for StevensJohnson syndrome and toxic epidermal necrolysis. Chung WH, Hung SI. loss of taste Derm: stevens-johnson syndrome, toxic epidermal necrolysis, rash, exfoliative dermatitis, hair . N Engl J Med. Arch Dermatol. Exfoliative dermatitis (ED) is defined as diffuse erythema and scaling of the skin involving more than 90% of the total body skin surface area. . Su SC, Hung SI, Fan WL, Dao RL, Chung WH. 2011;66(3):3607. These patches tend to spread until, after a matter of days or weeks, most of the skin surface is covered with an erythematous, pruritic eruption. View ABRIGO_Worksheet #8 Drug Study_Endocrine System.pdf from NCM 06 at Southern Luzon State University (multiple campuses). Allergy. 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. Google Scholar. Drug induced exfoliative dermatitis: State of the art - ResearchGate It characteristically demonstrates diffuse erythema and scaling of greater than 90% of the body surface area. Increased peripheral blood flow can result in high-output cardiac failure. Recombinant granulocyte colony-stimulating factor in the management of toxic epidermal necrolysis. Fritsch PO. Morel E, et al. Chung W-H, et al. A patch testing and cross-sensitivity study of carbamazepine-induced severe cutaneous adverse drug reactions. Int Arch Allergy Immunol. Effects of treatments on the mortality of StevensJohnson syndrome and toxic epidermal necrolysis: a retrospective study on patients included in the prospective EuroSCAR Study. A correlation between increased levels of perforin/granzyme B and the severity of TEN was also described [38]. 2007;48(5):10158. Erythema multiforme and toxic epidermal necrolysis. Garza A, Waldman AJ, Mamel J. Fritsch PO. Four cases are described, two of which were due to phenindione sensitivity. 2009;182(12):80719. 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]. J Allergy Clin Immunol. 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. Google Scholar. Clinical Considerations for Treatment and Prophylaxis of Mpox Infection See this image and copyright information in PMC. Even though there is a strong need for randomized trials, anti-TNF- drugs, in particular a single dose of infliximab 5mg/kg ev or 50mg etanercept sc should be considered in the treatment of SJS and TEN, especially the most severe cases when IVIG and intravenous corticosteroids dont achieve a rapid improvement. 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. EMs mortality rate is not well reported. Ibuprofene Zen * 20cps Mol 400mg Pemphigus vulgaris usually starts in the oral mucosa followed by blistering of the skin, which is often painful. Fritsch PO. Four main pathways have been found to play important roles in the pathogenesis of keratinocyte death: (1) Fas-FasL interaction, (2) Perforin/granzyme B pathway, (3) Granulysin and (4) Tumor necrosis factor (TNF-) [26]. Aminoglutethimide: Aminoglutethimide may lead to a loss of corticosteroid-induced adrenal suppression. Tohyama M, et al. Ganciclovir and cidofovir should be used when polymerase-chain reactions (PCR) on peripheral blood or other biological sample identifies a viral reactivation (HHV6, HHV7, EBV and CMV). Arch Dermatol. Soak for 5 to 10 minutes and rinse off before patting dry. Clin Exp Allergy. Unlike EMM, SJS and TEN are mainly related to medication use. A marker for StevensJohnson syndrome: ethnicity matters. Skin and appendages: acne, bruising, erythema multiforme, exfoliative dermatitis, pruritus ani, rash, skin ulceration, Stevens . 2005;136(3):20516. Pharmacogenomics J. While nearly any medication can, in theory, cause a reaction if you're sensitive, medications linked to exfoliative dermatitis include: sulfa drugs; penicillin and certain other antibiotics . 2010;88(1):608. 2015;21:13343. This is particularly true for patients with many comorbidities and poli-drug therapy, where it is advisable to monitor liver and kidney toxicity and to avoid Vitamin A excess [99]. The incidence of erythema multiforme, StevensJohnson syndrome, and toxic epidermal necrolysis. 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. Trautmann A, et al. Malignancies are a major cause of exfoliative dermatitis. Mawson AR, Eriator I, Karre S. StevensJohnson syndrome and toxic epidermal necrolysis (SJS/TEN): could retinoids play a causative role? Options include use of PUVA light therapy, total-body electron beam irradiation, topical nitrogen mustard, systemic chemotherapy and extracorporeal photopheresis. 2010 Oct;35(7):723-8. doi: 10.1111/j.1365-2230.2009.03718.x. ALDEN has shown a good accuracy to assess drug causality compared to data obtained by pharmacovigilance method and casecontrol results of the EuroSCAR casecontrol analysis for drugs associated with TEN. Lymphocyte transformation test (LTT) performed as described by Pichler and Tilch [77] shows a lower sensitivity in severe DHR compared to less severe DHR [78] but, if available, should be performed within 1week after the onset of skin rash in SJS and TEN [79]. Google Scholar. 2. Inhibition of toxic epidermal necrolysis by blockade of CD95 with human intravenous immunoglobulin. J. Shiga S, Cartotto R. What are the fluid requirements in toxic epidermal necrolysis? Diclofenac sodium topical solution, like other NSAIDs, can cause serious systemic skin side effects such as exfoliative dermatitis, SJS, and TEN, which may result in hospitalizations . 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]. Generalized exfoliative dermatitis, or erythroderma, is a severe inflammation of the entire skin surface. 2015;13(7):62545. Here we provide a systematic review on frequency, risk factors, pathogenesis, clinical features and management of patients with drug induced ED. The authors concluded for a potential beneficial effect of Cys A and a possible improvement in survival compared to IVIG. Interstitial nephritis is common in DRESS syndrome, occurring roughly in 40% of cases, whereas pre-renal azotemia may occur in SJS and TEN. Khalil I, et al. 2011;20(2):10712. FDA Drug information Dupixent Read time: 6 mins Marketing start date: 04 Mar 2023 . Allergy. Fitzpatricks dermatology in general medicine. StevensJohnson syndrome and toxic epidermal necrolysis. Wolkenstein P, et al. 1996;135(2):3056. Pregnancy . A recently published meta-analysis by Huang [110] and coworkers on IVIG in SJS/SJS-TEN/TEN reviewed 17 studies with 221 patients and compared the results obtained with high-dosage IVIG (>2g/kg) compared to lower-dosage IVIG (<2g/kg). SJS and TEN are two overlapping syndromes resembling severe burn lesions and characterized by skin detachment. Medication use and the risk of StevensJohnson syndrome or toxic epidermal necrolysis. 2. The more common forms of erythroderma, such as eczema or psoriasis, may persists for months or years and tend to relapse. 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]. d. Cysts and tumors. 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. Dupixent DUPILUMAB 200 mg/1.14mL sanofi-aventis U.S. LLC JDS | Journal of Dermatological Science | Vol 8, Issue 1, Pages 1-90 Exfoliative dermatitis is a rare inflammatory skin condition that is characterized by desquamation and erythema involving more than 90% of the body surface area. The timing of the rash can also vary. J Pharm Health Care Sci. Each of these physiologic disruptions is potentially life-threatening. Harr T, French LE. DailyMed - DICLOFENAC SODIUM- diclofenac sodium solution Hepatobiliary: jaundice, hepatitis, including . TEN is also known as Lyell syndrome, since it was first described by Alan Lyell in 1956 [2, 60]. Mockenhaupt M, et al. J Am Acad Dermatol. For carbamazpine, several studies have found a common link between specific HLAs and different kinds of cutaneous adverse reactions, as for HLA-A*3101 in Japanese [30] and Europeans [31]. Abe R. Toxic epidermal necrolysis and StevensJohnson syndrome: soluble Fas ligand involvement in the pathomechanisms of these diseases. Unauthorized use of these marks is strictly prohibited. 1998;282(5388):4903. Epilepsia. Hospitalization and dermatologic consultation are indicated in most cases to ensure that all of the necessary cutaneous, laboratory and radiologic investigations and monitoring are performed. Etanercept therapy for toxic epidermal necrolysis. Toxic epidermal necrolysis: Part I Introduction, history, classification, clinical features, systemic manifestations, etiology, and immunopathogenesis. J Eur Acad Dermatol Venereol. 12 out of 17 studies concluded for a positive role of IVIG in ED. Before J Am Acad Dermatol. This compressed maturation process results in an overall greater loss of epidermal material, which is manifested clinically as severe scaling and shedding. A review of DRESS-associated myocarditis. Case Rep Dermatol. Letko E, Papaliodis DN, Papaliodis GN, Daoud YJ, Ahmed AR, Foster CS. Br J Dermatol. Antibiotics: amoxicillin, ampicillin, ciprofloxacin, demeclocycline , doxycycline , minocycline, nalidixic acid, nitrofurantoin, norfloxacin, penicillin , rifampicin, streptomycin, tetracycline , tobramycin, trimethoprim, trimethoprim + sulphamethoxazole, vancomycin Anticonvulsants : barbiturates, carbamazepine Posadas SJ, et al. Erythema multiforme (EM), StevensJohnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Here we provide a systematic review of frequency, risk factors, molecular and cellular mechanisms of reactions, clinical features, diagnostic work-up and therapy approaches to drug induced ED. 2011;20(5):103441. Intravenous administration is recommended. Antibiotic therapy. [Erythema multiforme vs. Stevens-Johnson syndrome and toxic epidermal necrolysis: an important diagnostic distinction]. Panitumumab Induced Forearm Panniculitis in Two Women With Metastatic Med., 1976, 6, pp. Clinical and Molecular Allergy Exfoliative Dermatitis: Symptoms, Diagnosis & Treatments - Healthline Huff JC, Weston WL, Tonnesen MG. Erythema multiforme: a critical review of characteristics, diagnostic criteria, and causes. 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. Drug reaction with Eosinophilia and systemic symptoms (DRESS) syndrome can mimic SJS and TEN in the early phases, since ED can occur together with the typical maculo-papular rash. Read this article to find out all its symptoms, causes and treatments. Drug induced exfoliative dermatitis: state of the art, https://doi.org/10.1186/s12948-016-0045-0, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. 2012;13(1):4954. 2001;108(5):83946. 2010;5:39. It is also extremely important to obtain within the first 24h cultural samples from skin together with blood, urine, nasal, pharyngeal and bronchus cultures. In any case all authors concluded that the blockage of FasL prevents keratinocyte apoptosis [35]. Basal-cell carcinoma; Other names: Basal-cell skin cancer, basalioma: An ulcerated basal cell carcinoma near the ear of a 75-year-old male: Specialty Lin YT, et al. J Invest Dermatol. Drug-induced LPP. 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].