Drug-induced Liver Injury With Skin Reactions

Drugs and Host Risk Factors, Clinical Phenotypes and Prognosis

Harshad Devarbhavi; Sujata Raj


Liver International. 2019;39(5):802-811. 

In This Article


Many of the cases of non-immunologic skin rashes that occur with or without liver injury have a good prognosis. The presence of liver involvement particularly jaundice and associated comorbidities is a critical factor that determines outcome in DRESS and SJS/TEN. The mortality from DRESS syndrome, SJS and TEN however, is substantial with reported figures of 10%, 24% and 49% respectively.[70] Much of the mortality in DRESS syndrome is from involvement of internal organs, such as the liver, kidneys and lungs. While most patients recover from both skin and liver disease, the duration of recovery may be prolonged. Autoimmune diseases of the pancreas, thyroiditis may occur during convalescence and at times years later. Some patients required liver transplantation (Table 4). The outcome in SJS/TEN is mainly related to the extent of skin and mucus membrane involvement which often results in long-term skin, appendage and ocular morbidity. In the acute setting, sepsis and cholestasis may complicate the clinical picture. Liver involvement resulting in acute liver disease including liver failure and chronic cholestasis from VBDS both needing transplantation have been reported. Immunosuppressive drugs including steroids are the mainstay of treatment in the presence of hypersensitivity features with immunoglobulin and calcineurin inhibitors added when those unresponsive to steroids.