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J Dtsch Dermatol Ges 2022 06;20(6):777-786

German Center for the Documentation of Severe Skin Reactions (dZh), Department of Dermatologie, Medical Center and Medical Faculty - University of Freiburg, Germany.

Background: Stevens-Johnson syndrome and toxic epidermal necrolysis are severe, primarily drug-induced reactions of skin and mucosa. Since they differ in the extent of skin detachment but not in etiology, they are grouped together as epidermal necrolysis (EN). Due to nationwide registration, representative data are available at the German Center for the Documentation of Severe Skin Reactions (dZh). Read More

Arerugi 2022 ;71(4):328-333

Department of Pediatrics, Kasugai Municipal Hospital.

We describe here the case of a 7-year-old male patient with Stevens-Johnson syndrome (SJS), which was suspected to be caused by treatment with tipepidine hibenzate (Asverin). The day after taking tipepidine hibenzate and L-carbocysteine (Carbocysteine DS) for relief of a cold, he began presenting with the following symptoms: fever above 38°C, wheezing, and decreased oxygen saturation. Two days later, mucous membrane rashes, such as erosions on the lips, eye mucosa, vulva, and blisters on the trunk appeared, and SJS was thus diagnosed. Read More

Paediatr Drugs 2022 Jul 9;24(4):307-319. Epub 2022 Jun 9.

Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.

Pediatric Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threating blistering diseases triggered by medications that affect the skin and mucosae. Drug-induced epidermal necrolysis is a better term for medication-triggered cases because there is a spectrum of disease severity that otherwise is divided into the separate entities of SJS, overlap SJS/TEN, and TEN. This manuscript reviews the management of drug-induced epidermal necrolysis (DEN), including diagnosis, investigations to exclude differential diagnoses, and treatment. Read More

Int Immunopharmacol 2022 Aug 5;109:108804. Epub 2022 May 5.

Institute of Neuroscience and Department of Neurology of the Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou 510260, China. Electronic address:

Background: Previous studies have demonstrated that human leukocyte antigen (HLA)-A*24:02 is a common genetic risk factor for antiepileptic drug-induced skin rash, while HLA-B*15:02 is a specific risk factor for carbamazepine (CBZ)-induced Stevens Johnson syndrome and toxin epidermal necrolysis. The HLA-B*15:02 allele can alter the repertoire of endogenous peptides to trigger CBZ-induced hypersensitivity. However, it is uncertain whether HLA-A*24:02 could produce alterations in the peptide repertoire during treatment with antiepileptic drugs. Read More

Crit Care Clin 2022 Apr;38(2):243-269

Department of Dermatology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.

There have been major advances in the understanding of severe cutaneous adverse reactions (SCARs). Early recognition and withdrawal of culprit medications can decrease morbidity and mortality significantly. SCARs encompass a variety of entities that present with extensive mucocutaneous involvement and systemic symptoms, often requiring management in an intensive care setting. Read More

Lupus 2022 May 24;31(6):650-658. Epub 2022 Mar 24.

Pulmonology Department NHS, 37794General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, Greece.

Drug-induced lupus erythematosus (DILE) accounts for 10-15% of systemic lupus erythematosus (SLE) cases, with more than 100 pharmaceutical agents implicated in its development. Depending on the offending drug, clinical and serological manifestations present great variability and, thus, DILE may be overlooked in clinical practice. Valproic acid (VPA) - induced lupus erythematosus has not been analytically reported in the literature, rendering the recognition of such cases even more difficult. Read More

Ocul Surf 2022 04 2;24:83-92. Epub 2022 Mar 2.

Centre for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, Telangana, India; The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India. Electronic address:

Drug induced cicatrizing conjunctivitis (DICC) is defined as a disease in which conjunctival cicatrization develops as a response to the chronic use of inciting topical and, rarely, systemic medications. DICC accounts for up to one third of cases of pseudopemphigoid, a large group of cicatrizing conjunctival diseases sharing similar clinical features to those of mucous membrane pemphigoid (MMP) but generally without the morbidity of progressive scarring or the need for systemic immunosuppression. The preservatives in topical anti-glaucoma medications (AGM) are the most frequently implicated inciting causes of DICC although topical antivirals, vasoconstrictors and mydriatics and some systemic drugs have been implicated. Read More

J Am Acad Dermatol 2022 07 1;87(1):56-63. Epub 2022 Mar 1.

Molecular and Cell Biology Laboratory, IDI-IRCCS, Rome, Italy. Electronic address:

Background: Recently, several case-control studies demonstrated an association between gliptins and bullous pemphigoid (BP) occurrence. However, data on the clinical and immunologic features of gliptin-associated bullous pemphigoid (GABP) are controversial.

Objective: This study aimed to clinically and immunologically characterize a large cohort of GABP patients to get an insight into the pathophysiology of this emerging drug-induced variant of BP. Read More

Allergol Int 2022 Apr 27;71(2):185-192. Epub 2022 Feb 27.

Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan.

Non-HIV immune reconstitution inflammatory syndrome (non-HIV IRIS) is associated with the recovery from an immunocompromised condition. It is defined as inflammatory disorders caused by antigens, including drugs or pathogenic microorganisms present prior to immune recovery, or by the exacerbation of an inflammatory disorder that was already present. Drug-induced hypersensitivity syndrome is a prototype of IRIS, and the pathophysiology of non-HIV IRIS can be recognized in several disorders treated with corticosteroids, immunosuppressants, molecular-targeted drugs, TNF-α antibody drugs, immune checkpoint inhibitors, and dipeptidyl peptidase-4 inhibitors. Read More

Medicina (Kaunas) 2022 Feb 11;58(2). Epub 2022 Feb 11.

Department of Gastroenterology, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan.

A 41-year-old man was treated with prednisolone (PSL) and multimatrix (MMX) mesalamine for remission induction therapy of ulcerative colitis. PSL was tapered due to successful remission induction treatment. During the treatment course, ocular foreign body sensation, eyelid swelling, ocular conjunctiva hyperemia, facial redness and swelling, watery nasal discharge, stomatitis, anal pain, and reddish puffiness on the bilateral dorsum of the hands appeared, and he was diagnosed with Stevens-Johnson syndrome (SJS). Read More

JAAD Case Rep 2022 Mar 6;21:56-58. Epub 2022 Jan 6.

Department of Dermatology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.

J Transl Med 2021 12 20;19(1):520. Epub 2021 Dec 20.

Institute of Dermatology, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy.

Bullous pemphigoid (BP) is the most common autoimmune bullous skin disease that affects primarily patients older than 60 years. The majority of BP cases are spontaneous, but BP can also be triggered by certain drugs' exposures. Since 2011, a growing number of observations has been reporting cases of BP in Type 2 diabetic patients. Read More

Hua Xi Kou Qiang Yi Xue Za Zhi 2021 Dec;39(6):724-727

State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.

Drug-induced pemphigus (DIP) is a special type of pemphigus, and its pathogenesis, characteristics of treatment, and prognosis are closely related to the inducing drugs. This article reports the diagnosis and treatment of DIP (pemphigus vulgaris) caused by the administration of rifampin to a patient with tuberculosis. Combined with the literature, we discussed the types, pathogenesis, differential diagnosis, and treatment principles of DIP. Read More

Dermatol Ther 2022 01 30;35(1):e15207. Epub 2021 Nov 30.

Department of Health and Science (Dissal), Section of Dermatology, University of Genoa, Polyclinic Hospital San Martino, IRCCS, Genoa, Italy.

Drug-induced bullous pemphigoid (DBP) associated to biologics administered for psoriasis is rare. DBP has been described especially in association with anti-TNF-α drugs and anti-IL12 and 23, but never in relation to guselkumab (anti-IL23). We report the case of a 76-year-old male patient with severe psoriasis (PASI 20), presenting with generalized tense bullae and erosions after being recently switched to guselkumab therapy. Read More

Clin Exp Dermatol 2022 Mar 21;47(3):609-611. Epub 2021 Nov 21.

Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan.

Sultan Qaboos Univ Med J 2021 Aug 29;21(3):491-494. Epub 2021 Aug 29.

Department of Medicine, Rustaq Hospital, Rustaq, Oman.

Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute life-threatening mucocutaneous drug reactions. Several therapies have been used in the treatment of SJS/TEN but none of them have yet been established as the gold standard treatment. Studies have shown that cyclosporine (CsA) can be used off-label in TEN/SJS, which has shown promising therapeutic effectiveness in such diseases. Read More

Medicina (Kaunas) 2021 Aug 16;57(8). Epub 2021 Aug 16.

Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy.

: Erythema multiforme (EM) is an acute cutaneous eruption often associated with infections and more rarely with drugs. This review aimed to evaluate the association between erythema multiforme and coronavirus disease 2019 (COVID-19). : A systematic search of PubMed/MEDLINE, Scimago Scopus, and ISI/Web of Science was performed. Read More

J Allergy Clin Immunol Pract 2021 12 9;9(12):4483-4485.e1. Epub 2021 Aug 9.

Division of Dermatology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Combined Drug Allergy Clinic, Groote Schuur Hospital, Cape Town, South Africa. Electronic address:

J Int Med Res 2021 Jul;49(7):3000605211033196

Department of Dermatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a life-threatening mucocutaneous disease that is predominantly drug-induced. Warfarin is the most commonly used drug for long-term anti-coagulant therapy; however, warfarin-induced SJS/TEN is seldom reported. In this study, we presented the case of a 61-year-old man who developed SJS after receiving multiple-drug therapy following aortic valve replacement surgery. Read More

Int J Dermatol 2022 May 24;61(5):591-594. Epub 2021 Jul 24.

Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, USA.

Background: Grover's disease (GD) is a relatively rare transient dermatosis that can be idiopathic or acquired. Acquired GD may occur secondary to internal triggers such as medications and malignancies and external factors such as friction.

Objective: The purpose of this report is to describe the clinical and histological presentation of drug-induced Grover's disease (DIGD) and discuss potential pathogenic mechanisms. Read More

Int Immunopharmacol 2021 Oct 18;99:107967. Epub 2021 Jul 18.

The Hershey Medical Center Department of Dermatology, Hershey, PA, United States.

Cureus 2021 May 30;13(5):e15330. Epub 2021 May 30.

Pathology, Liaquat National Hospital and Medical College, Karachi, PAK.

Introduction A vesiculobullous lesion of the skin encompasses a group of dermatological disorders with protean clinicopathological features. They usually occur as a part of the spectrum of various infectious, inflammatory, drug-induced, genetic, and autoimmune disorders. Therefore, accurate diagnosis of these lesions is essential for appropriate management and to reduce the associated morbidity and mortality. Read More

Curr Drug Res Rev 2022 ;14(1):80-83

Department of Pharmacy Practice, SRM College of Pharmacy, SRM IST, Kattankulathur-603203, Kancheepuram, Tamil Nadu, India.

Objective: To report a rare case of drug induced overlap of Stevens-Johnson syndrome and Toxic Epidermal Necrosis Syndrome exacerbated by cephalexin.

Case Presentation: In this case report, we present a 65-year-old female who had come to the hospital with complaints of Sloughing of the skin and redness all over the body with raised body temperature. She was on therapeutic Phenytoin to prevent the post-surgical complications of Communicating Hydrocephalus. Read More

Biomolecules 2021 06 6;11(6). Epub 2021 Jun 6.

Department of Dermatology, Nara Medical University School of Medicine, 840 Shijo, Kashihara, Nara 634-8522, Japan.

Although the incidence of severe cutaneous adverse reactions (SCARs) to medications is very low, SCARs can result in disability or even death if they are not diagnosed and treated properly. As the rapid recognition of SCARs is essential, it is necessary to develop diagnostic markers for them that can also be used to assess severity and predict outcomes in the early phase. In addition, it is important to identify novel therapeutic targets for SCARs. Read More

Liver Int 2021 11 6;41(11):2671-2680. Epub 2021 Jul 6.

Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, & National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan.

Background & Aims: Severe cutaneous adverse drug reactions (SCARs) including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP) are high-mortality adverse drug reactions. The risk factors and prognosis of drug-induced liver injury (DILI) concomitant with SCAR warrant clarification. We aimed to evaluate the characteristics and outcomes of DILI with SCAR. Read More

Expert Opin Drug Metab Toxicol 2021 Sep 8;17(9):1049-1064. Epub 2021 Jul 8.

Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Pharmacogenomics has great potential in reducing drug-induced severe cutaneous adverse drug reactions (SCARs). Pharmacogenomic studies have revealed an association between genes and SCARs including acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). Pharmacogenomics-guided therapy could prevent severe drug hypersensitivity reactions. Read More

Curr Drug Saf 2022 ;17(1):40-46

Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry-605006, India.

Background And Objective: Identification of the offending drug is crucial and challenging in cases of severe cutaneous adverse drug reactions (CADR) like Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Poor reproducibility and varying levels of agreement have been observed among different causality assessment tools (CATs) in assessing severe CADRs. This study was conducted to examine the agreement among four different CATs in assessing cases of drug-induced SJS, TEN and SJS/TEN overlap. Read More

Exp Dermatol 2021 09 24;30(9):1345-1351. Epub 2021 May 24.

Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Background: Many studies have corroborated the association of dipeptidyl peptidase-4 inhibitors (DPP4i) use with bullous pemphigoid (BP). It has been speculated that this drug-induced variant presents with a different clinical spectrum than conventional BP.

Objective: To determine the prevalence of DPP4i-induced cases of BP and to evaluate whether gliptin-related BP has specific clinicopathological and immunological features. Read More

Front Immunol 2021 16;12:665522. Epub 2021 Apr 16.

Molecular and Cell Biology Laboratory IDI-IRCCS, Rome, Italy.

COVID-19 is characterized by a severe pulmonary disease due to severe acute respiratory syndrome (SARS)-CoV-2 infection. For clinicians involved in the management of patients with chronic autoimmune diseases the risk linked to the conditions itself and to drug-induced immunosuppression during the COVID-19 pandemic is a major topic. Pemphigus is a rare autoimmune blistering disease (AIBD) of the skin and mucous membranes caused by autoantibodies to desmosomal components, desmoglein 1 and 3. Read More

J Am Acad Dermatol 2022 04 26;86(4):811-817. Epub 2021 Apr 26.

Department of Dermatology, Singapore General Hospital, Singapore, Singapore. Electronic address:

Background: Mycoplasma pneumoniae (MP) infection is associated with extrapulmonary complications such as Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN).

Objective: We evaluated the differences in epidemiology, clinical characteristics, and disease outcomes between drug-induced and Mycoplasma-related SJS/TEN.

Methods: All patients with SJS/TEN admitted to our center between 2003 and 2016 inclusive were treated under a standardized protocol. Read More