Drug-induced Skin Disorders

Valerie Clinard, PharmD; Jennifer D. Smith, PharmD, CPP, BC-ADM, CDE

Disclosures

US Pharmacist 

In This Article

Abstract and Introduction

Introduction

Adverse drug reactions (ADRs) are a major health concern, and occur in 0.1% to 1% of patients taking systemic medications.[1,2] The incidence of fatalities due to all drug reactions for hospitalized patients has been documented to be 0.3%.[2] The skin is the largest organ in the body, and adverse skin reactions due to drug exposure are a common problem. Approximately 2% of drug-induced skin eruptions meet the World Health Organization definition of a serious reaction.[1,3] The exact mechanism for many of the drug-induced cutaneous diseases is not fully understood and may result from both immune and nonimmune mechanisms. Properties of a drug that increase the risk of a drug-induced hypersensitivity reaction are: 1) molecular weight >4,000 Da (e.g., insulin, erythropoietin); 2) presence of foreign proteins or large polypeptides of nonhuman origin (streptokinase, beef or pork insulin, chimeric/murine-derived monoclonal antibodies); or 3) the ability of the parent drug or its active metabolite to bind to a carrier protein and form a complete antigen (penicillins and sulfonamides).[4]

Drug-induced skin disorders are often classified as either acute or chronic. Acute diseases include erythematous eruptions; urticaria, angioedema, and anaphylaxis; fixeddrug eruptions; hypersensitivity syndrome; Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN); warfarin-induced skin necrosis; vasculitis; serum sickness–like reaction; acute generalized exanthematous pustulosis (AGEP); and photosensitivity. Chronic disorders include drug-induced lupus, drug-induced acne, and pigmentary changes.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....