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


Although current knowledge has highlighted the contributing role of different HLA alleles or other genotypic markers in the pathogenesis of DISI and DILI, their role in concurrent DILI and DISI is lacking. Although conditions such as DRESS and to a lesser extent SJS/TEN are associated with liver injury of varying severity, there is lack of information why certain individuals develop the subtype with concurrent liver and skin injury. HLA alleles are necessary for occurrence of many of the skin reactions, but they are not sufficient, suggesting involvement of non-genetic factors in adverse drug reaction. The high negative predictive value of these tests combined with high prevalence of the specific genotypes in the population have resulted in some societies and countries recommending genetic testing before the use of drugs with the potential for adverse drug reaction; this is in order to prevent cutaneous SCAR and associated organ involvement. However, more research is needed in order to understand the various facets including pathogenesis, severity and outcome of concurrent skin and liver injury phenotype.