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American Journal of Clinical Dermatology

Published in:

01-08-2003 | Review Article

Differential Diagnosis of Severe Cutaneous Drug Eruptions

Authors: Dr Nicolas Bachot, Jean-Claude Roujeau

Published in: American Journal of Clinical Dermatology | Issue 8/2003

Abstract

Adverse cutaneous reactions to drugs are frequent, mostly secondary to antibacterials, however, serious adverse cutaneous reactions are infrequent. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are a spectrum of the same disease. They are the more severe drug eruptions, with a mortality around 30% for TEN. The confusion between erythema multiforme major and SJS means that erythema multiforme major is the main differential diagnosis. Skin disorders involving desquamation, in particular after pustulosis, are also common differential diagnoses. Mechanical or autoimmune blistering are also potential misdiagnoses of TEN/SJS.

Hypersensitivity Syndrome (HSS) or Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) is a severe cutaneous drug reaction with often a long duration of eruption and serious other organ involvement. Exfoliative dermatitis, whether caused by psoriasis, dermatitis or lymphoma, can be thought of as a differential diagnosis of DRESS/HSS. Angio-immunoblastic lymphadenopathy, viral eruption and vasculitis are other differential diagnoses of DRESS/HSS.

Prompt recognition of a severe drug reaction and withdrawal of the culprit drug is often the most important therapeutic action. Alternatively, a delay in starting a specific treatment for a disease misdiagnosed as a drug eruption could be deleterious.

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Title: Differential Diagnosis of Severe Cutaneous Drug Eruptions
Authors: Dr Nicolas Bachot
Jean-Claude Roujeau
Publication date: 01-08-2003
Publisher: Springer International Publishing
Published in: American Journal of Clinical Dermatology / Issue 8/2003
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI: https://doi.org/10.2165/00128071-200304080-00006

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Differential Diagnosis of Severe Cutaneous Drug Eruptions

Abstract

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