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Int J Womens Dermatol 2019 Jun 24;5(2):92-95. Epub 2019 Jan 24.

Department of Dermatology, Maulana Azad Medical College, New Delhi, India.

Linear immunoglobulin A disease (LAD) is a rare, autoimmune, vesicular-bullous disease that is either idiopathic or drug-induced, most commonly by vancomycin and in rare instances by amlodipine. In drug-induced LAD, certain uncommon and atypical clinical features can occur. In our patient, a 49-year-old woman with amlodipine-induced LAD, atypical features such as koebnerization and palmo-plantar involvement occurred. Read More

Am J Case Rep 2019 Feb 18;20:212-218. Epub 2019 Feb 18.

Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL, USA.

BACKGROUND The hallmark of bullous pemphigoid (BP) is widespread tense blisters arising on normal or erythematous skin, often with marked pruritus, the diagnosis of which is confirmed by direct immunofluorescence (DIF). BP is an autoimmune process that can be induced, though rarely, by medications. Drug-induced BP often has atypical clinical presentation, which requires a good understanding of other dermatological conditions with similar presentations, in particular, bullous subtype of erythema multiforme. Read More

J Am Acad Dermatol 2019 Mar 26;80(3):608-616. Epub 2018 Oct 26.

Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medical College, New York, New York. Electronic address:

Background: Severe cutaneous adverse reactions (SCARs) are frequent in inpatient oncology. Early intervention might reduce morbidity, mortality, and hospitalization costs; however, current clinical and histologic features are unreliable SCAR predictors. There is a need to identify rational markers of SCARs that could lead to effective therapeutic interventions. Read More

Pediatr Dermatol 2019 Jan 26;36(1):e27-e30. Epub 2018 Nov 26.

Department of Oral Surgery and Pathology, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

Drug-induced reactions are complications associated with high mortality and significant morbidity. Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are examples of these conditions, which are characterized by skin and mucous lesions. Here, we report a case of a 9-year-old girl who presented with blisters associated with an extensive vesicular rash and multiple ulcerations on the lips and oral cavity. Read More

J Clin Pharm Ther 2019 Feb 8;44(1):115-118. Epub 2018 Oct 8.

Division of Gastroenterology and Hepatology, Department of Medicine, Cook County Health and Hospital System, Chicago, Illinois.

What Is Known And Objective: Drug-induced liver injuries (DILI) are overall rare and often associated with use of medications. Medications are also the most common aetiology of Stevens-Johnson syndrome (SJS), but SJS is seldom seen concomitantly with liver injury. Many common drugs can cause either one of these conditions; however, there are no reported cases of concomitant DILI and SJS secondary to fluoxetine. Read More

J Am Acad Dermatol 2018 12 1;79(6):1026-1027. Epub 2018 Oct 1.

Division of Dermatology, Cooper Medical School of Rowan University, Marlton, New Jersey. Electronic address:

Medicine (Baltimore) 2018 Sep;97(38):e12338

Department of Ophthalmology, The Affiliated Guangren Hospital of Xi'an Jiaotong University.

The application of methotrexate (MTX) in the treatment of autoimmune diseases has been gradually increasing, but reports of MTX treatment for advanced ocular cicatricial pemphigoid (OCP) are extremely rare. This study investigated the efficacy and adverse reactions of low-dose MTX in patients with OCP.This was a retrospective, noncontrolled, case series study. Read More

PLoS One 2018 7;13(9):e0203642. Epub 2018 Sep 7.

Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan.

Background: Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome are severe drug-induced cutaneous adverse reactions with high mortality. Acute kidney injury (AKI) was a common complication in an SJS/TEN group and noted as an independent risk factor for mortality in patients with SJS/TEN. To determine whether AKI staging can predict the outcome of patients with SJS/TEN, we compared the discriminative power of an AKI KDIGO staging system with that of SCROTEN, APACHE II, APACHE III, and SOFA. Read More

Dermatol Online J 2018 May 15;24(5). Epub 2018 May 15.

Naval Health Clinic Quantico, Quantico, Virginia.

Drug induced linear IgA bullous dermatosis (LABD) is a rare blistering disease that has been shown to be associated with the use of various medications. Although rarely seen together, some of the medications associated with LABD can lead to the syndrome drug reaction with eosinophilia and systemic symptoms (DRESS), which presents with fever, cutaneous eruption, and multi-organ involvement. We present a patient who developed fever and a generalized vesiculobullous eruption after recently starting amlodipine and meloxicam. Read More

J Clin Pharm Ther 2019 Feb 20;44(1):69-77. Epub 2018 Aug 20.

Laboratoire de Pharmacologie Médicale et Clinique (Medical and Clinical Pharmacology Laboratory), Faculté de Médecine de l'Université Paul-Sabatier (Faculty of Medicine, Paul-Sabatier University), Toulouse, France.

What Is Known And Objective: Despite the numerous studies investigating drug-induced Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), the understanding and quantitative data in developing countries remain limited. The study aimed to describe and quantify the drug-related risk of SJS/TEN in a resource-limited context using the Vietnamese spontaneous reporting database (VSRD) of adverse drug reactions.

Methods: Spontaneous reports relating to medium- and late-onset severe cutaneous adverse reactions (MLOSCAR) and SJS/TEN recorded in the VSRD from 2010 to 2015 were retrospectively analysed. Read More

Cutis 2018 Jun;101(6):458-461

Department of Dermatology and Venereology, Government Medical College, Trivandrum, Kerala State, India.

Methicillin-resistant (MRSA) has emerged worldwide as a major nosocomial pathogen that causes notable morbidity and mortality, especially in vesiculobullous disorders. To study the prevalence of MRSA among patients with autoimmune bullous and drug-induced vesiculobullous disorders and elucidate its predisposing factors and associated mortality, we conducted a prospective, descriptive, 1-year study of all vesiculobullous patients admitted to a tertiary-care center. The prevalence of MRSA in this study was high (32. Read More

BMJ Case Rep 2018 Jul 17;2018. Epub 2018 Jul 17.

Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Manila, Philippines.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are two related mucocutaneous disorders with different severities. Although the incidence is low, SJS and TEN are life-threatening and predominantly drug-induced conditions. There is a strong relationship between the allele and carbamazepine-induced SJS and TEN in different Southeast Asian populations. Read More

J Immunol Res 2018 10;2018:7645465. Epub 2018 Jun 10.

Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa.

Drug-induced hypersensitivity immune reactions are exaggerated immunoinflammatory responses to allergenic components of the medications that occur in genetically susceptible subjects. The type of hypersensitivity immune response generated, whether antibody mediated or T cell mediated, or an immune complex reaction is determined by multiple factors, including the molecular characteristics of the allergen, the route of administration of the medication, the manner of presentation of the allergen by antigen-presenting cells to naïve T cells, the repertoire of the T cell receptors, and the cytokine profile within the microenvironment. This review deals with the clinical and histopathological aspects of adverse immunologically mediated oral mucosal reactions to systemic medication. Read More

Int J Dermatol 2018 11 5;57(11):e131-e134. Epub 2018 Jul 5.

Department of Dermatology, Dokkyo Medical University, School of Medicine, Mibu, Tochigi, Japan.

J Formos Med Assoc 2019 Jan 23;118(1 Pt 2):371-377. Epub 2018 Jun 23.

Taiwan Drug Relief Foundation, Taipei, Taiwan. Electronic address:

Background/purpose: Previous studies have reported that the indication and starting dose of allopurinol may be associated with the incidence of hypersensitive reactions. As allopurinol-related severe cutaneous adverse reactions (SCARs) constitute a significant proportion of drug injury relief applications in Taiwan, this study sought to examine allopurinol use and related adverse reactions through an analysis of recent drug injury relief applications.

Methods: Allopurinol-related drug injury relief applications from 1999 to 2016 were collected, and descriptive statistical methods were used to analyze recent applications dating from 2011 to 2016. Read More

Pediatr Int 2018 Aug 30;60(8):697-702. Epub 2018 Jul 30.

Division of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan.

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, but these conditions are associated with high mortality. There have been few reports of SJS and TEN in children. The aim of this study was to evaluate the clinical features and outcomes of SJS and TEN in a group of Japanese children. Read More

Cutis 2018 Apr;101(4):293-296

Division of Dermatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Linear IgA bullous dermatosis (LABD) is an autoimmune blistering rash caused by IgA autoantibodies against the epidermal basement membrane zone. It commonly is drug induced, often in association with systemic vancomycin. We report a case of a previously healthy 77-year-old man who developed a diffuse macular rash and hemorrhagic bullae on the left leg 10 days after placement of a vancomycin-impregnated cement spacer (VICS) during a revision knee arthroplasty and initiation of postoperative treatment with intravenous (IV) vancomycin. Read More

Lupus 2018 Jul 9;27(8):1383-1386. Epub 2018 Apr 9.

1 Division of Rheumatology, University of Michigan Medical School, USA.

A 29-year-old woman with a 1.5 year history of photosensitive skin lesions on her hands presented with a malar rash, bullous lesions on her hands, and was diagnosed with subacute lupus erythematosus after serologies revealed a positive antinuclear antibody test (1:2560), and antibodies to Ro/SSA and dsDNA. Hydroxychloroquine (400 mg/day) was prescribed and the patient developed severe drug-induced liver injury. Read More

Dermatol Online J 2017 Aug 15;23(8). Epub 2017 Aug 15.

Department of Dermatology, Hôpital Nord, University of Amiens, Amiens, France.

Background: Linear IgA bullous dermatosis (LABD) is an autoimmune blistering skin disorder characterized by linear IgA deposits along the dermoepidermal junction. Usually idiopathic, LABD can be drug-induced.

Objective: To report the atypical characteristics of a case of trimethoprim-sulfamethoxazole-induced LABD presenting as toxic epidermal necrolysis (TEN). Read More

Dermatol Online J 2017 Nov 15;23(11). Epub 2017 Nov 15.

Beth Israel Deaconess Medical Center, Department of Pathology, Harvard Medical School, Boston, Massachusetts.

Background: Linear IgA bullous dermatosis (LABD) is an autoimmune subepidermal blistering disease usually with a neutrophil rich inflammatory infiltrate, and characterized by linear IgA deposition at the basement membrane zone (BMZ), and neutrophil predominant dermal inflammation. We report a case of LABD with numerous eosinophils and flame figure formation, a unique histopathologic finding not previously reported. A 69-year-old woman presented with a rapidly progressive, intensely pruritic rash over forearms, breasts, axillae, hips, and thighs. Read More

J Dermatol 2018 May 11;45(5):592-595. Epub 2018 Feb 11.

Department ofDermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.

We report two rare cases of childhood epilepsy patients who developed ethosuximide-induced Stevens-Johnson syndrome (SJS). Unlike typical SJS, the initial eruption of both patients presented well-demarcated, infiltrating firm papules mainly on the cheeks and the extensor aspects of the arms (case 1), and multiple vesicles on the soles and oral aphthosis (case 2), which closely mimicked viral exanthema. We diagnosed both patients with ethosuximide-induced SJS, based on the dosing period and the positive results of drug-induced lymphocyte stimulation test. Read More

Ann Afr Med 2018 Jan-Mar;17(1):43-45

Department of Oral and Maxillofacial Surgery Sciences, Division of Oral Pathology and Microbiology, Najran University College of Dentistry, Najran, Saudi Arabia.

Trimethoprim-sulfamethoxazole (cotrimoxazole or TMP/SMX) is commonly used for the treatment of urinary or lower respiratory tract infections. A comprehensive review is presented of the world literature on adverse reactions to TMP/SMX since its first use in 1968, when concern was expressed about possible hematologic toxicity. The adverse reactions to TMP/SMX occur in approximately 1%-3% of persons in general population. Read More

Ann Pathol 2018 Feb 24;38(1):7-19. Epub 2017 Dec 24.

Département de pathologie, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France. Electronic address:

There are many different types of cutaneous adverse reactions. The most classical reactions are driven by T lymphocytes that specifically react towards a drug, with an individual genetic susceptibility linked to certain type I major histocompatibility complex alleles. These reactions are characterized by a wide variety of clinical and histopathological presentations, and a wide range of severity. Read More

Int J Dermatol 2018 Mar 20;57(3):332-338. Epub 2017 Dec 20.

Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: Short-term mucocutaneous adverse effects are well documented with imatinib. However, studies on long-term adverse effects and in the ethnic population are lacking.

Objective: To study the long-term mucocutaneous adverse effects of imatinib and factors predicting these adverse effects. Read More

J Immunol Res 2017 31;2017:6928363. Epub 2017 Oct 31.

Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.

Diagnosis of severe cutaneous adverse drug reactions should involve immunohistopathological examination, which gives insight into the pathomechanisms of these disorders. The characteristic histological findings of erythema multiforme (EM), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) provide conclusive evidence demonstrating that SJS/TEN can be distinguished from EM. Established SJS/TEN shows full-thickness, extensive keratinocyte necrosis that develops into subepidermal bullae. Read More

Eur J Dermatol 2017 12;27(6):664-665

Department of Dermatology, Faculty of Medicine, Oita University, Hasama, Yufu, 879-5593, Japan.

Arch Dermatol Res 2018 Mar 6;310(2):95-106. Epub 2017 Nov 6.

Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Pemphigus is a general term for a rare group of autoimmune diseases which result in the formation of blisters on the skin and oral cavity. Although there is no way to prevent autoimmune diseases, some factors may trigger pemphigus initiation in susceptible individuals or be exacerbated in affected patients. Recognition of these triggers, based on the latest studies and experiences is essential and should be updated every few years. Read More

Clin Pharmacol Ther 2018 03 6;103(3):390-394. Epub 2017 Nov 6.

Department of Medicine (Dermatology and Clinical Pharmacology and Toxicology), University of Toronto, Toronto, Canada.

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is one of the most devastating of adverse drug reactions (ADRs) and was, until recently, essentially unpredictable. With the discovery of several risk alleles for drug-induced SJS/TEN and the demonstration of effectiveness of screening in reducing incidence, the stage is set for implementation of preventive strategies in populations at risk. Yet much remains to be learned about this potentially fatal complication of commonly used drugs. Read More

Surg Pathol Clin 2017 Dec 23;10(4):765-779. Epub 2017 Sep 23.

Department of Pathology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10467, USA. Electronic address:

Esophagitis results from diverse causes, including gastroesophageal reflux, immune-mediated or allergic reactions, therapeutic complications, and infections. The appropriate clinical management differs in each of these situations and is often guided by pathologic interpretation of endoscopic mucosal biopsy specimens. This review summarizes the diagnostic features of unusual forms of esophagitis, including eosinophilic esophagitis, lymphocytic esophagitis, esophagitis dissecans superficialis, drug-induced esophageal injury, and bullous disorders. Read More

BMJ Case Rep 2017 Oct 20;2017. Epub 2017 Oct 20.

Department of Gastroenterology, PVS Memorial Hospital, Cochin, Kerala, India.

A middle-aged man with decompensated cirrhosis and a dimorphic multisite skin rash is diagnosed with rare atypical herpes simplex infection, manifesting Sweet's syndrome (SS) in the absence of other described associations. SS, an acute febrile neutrophilic dermatosis, has three common forms-classical or idiopathic, malignancy associated and drug induced. Systemic autoimmune, connective tissue diseases and infections are also strong associations. Read More

Br J Clin Pharmacol 2018 02 10;84(2):331-338. Epub 2017 Nov 10.

Centre Régional de Pharmacovigilance, CHU - Centre de Biologie, EA 4681 PEPRADE, Université d'Auvergne, 58 Rue Montalembert -BP 69, 63003 Cedex 1, Clermont-Ferrand, France.

Aim: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe mostly drug-induced cutaneous reactions. Acetaminophen is an over-the-counter drug used worldwide to treat pain and reduce fever. In 2013, the US Food and Drug Administration informed the public that acetaminophen was associated with a rare risk of SJS/TEN. Read More

Clin Exp Dermatol 2017 Dec 20;42(8):868-873. Epub 2017 Sep 20.

Department of Dermatology, Venereology and Andrology , Assiut University, Egypt.

Background: There is strong evidence that drug-induced cutaneous eruptions have an immunological component. Interleukin (IL)-17, a proinflammatory cytokine that is predominantly produced by T helper 17 cells, has been linked to various autoimmune and inflammatory diseases.

Aim: To measure serum IL-17 levels in patients with cutaneous drug reactions [erythema multiforme (EM) and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN)] in order to study the associations between IL-17 and disease severity. Read More

Zhong Nan Da Xue Xue Bao Yi Xue Ban 2017 Aug;42(8):953-957

Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China.

Objective: To explore the clinical characteristics of various types of severe drug eruption and common sensitized drugs, and to provide clinical references for reducing the incidence of severe drug eruption.
 Methods: The clinical data regarding 126 cases of severe drug eruption were analyzed retrospectively from June 2009 to May 2017 in Xiangya Hospital, Central South University.
 Results: In the 126 cases of severe drug eruption, the distribution of men and women ratio was 1:1. Read More

Biol Pharm Bull 2017 ;40(9):1576-1580

Division of Medicinal Safety Science, National Institute of Health Sciences.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse drug reactions. Recent studies have revealed that the prevalence of SJS/TEN is associated with genetic backgrounds, such as polymorphisms in human leukocyte antigens (HLAs). However, non-genetic factors contributing to the etiology of SJS/TEN are largely unknown. Read More

BMC Ophthalmol 2017 May 12;17(1):65. Epub 2017 May 12.

Department of Ophthalmology, The University of Hong Kong, Room 301, Level 3, Block B, Cyberport 4, 100 Cyberport Road, Pok Fu Lam, Hong Kong.

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening conditions that initially affect the skin and mucous membranes. The aim of this study was to compare the acute ocular manifestations between SJS and TEN.

Methods: The initial presenting ophthalmic records of patients with either SJS (<30% body surface area involvement) or TEN (> = 30% involvement), who were treated at one tertiary burn center in Hong Kong between 1999 and 2014, were retrospectively analyzed and compared. Read More

Neurology 2017 Jun 5;88(23):2183-2191. Epub 2017 May 5.

Author affiliations are provided at the end of the article.

Objective: To investigate the involvement of human leukocyte antigen (HLA) loci in aromatic antiepileptic drug-induced cutaneous adverse reactions.

Methods: A case-control study was performed to detect HLA loci involved in aromatic antiepileptic drug-induced Stevens-Johnson syndrome in a southern Han Chinese population. Between January 1, 2006, and December 31, 2015, 91 cases of Stevens-Johnson syndrome induced by aromatic antiepileptic drugs and 322 matched drug-tolerant controls were enrolled from 8 centers. Read More

Indian J Dermatol Venereol Leprol 2017 May-Jun;83(3):312-316

Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India.

Background: Toxic epidermal necrolysis and Stevens-Johnson syndrome comprise life-threatening, drug-induced mucocutaneous disease spectrum. Interest in cyclosporine, a calcineurin inhibitor that can block the function of T-cells, has increased with the discovery of the importance of granulysin in apoptosis in toxic epidermal necrolysis. In our hospital, cyclosporine is given to Stevens-Johnson syndrome/toxic epidermal necrolysis patients as an adjunctive therapy. Read More

Eur J Ophthalmol 2017 Nov;27(6):658-663

1 Section of Ophthalmology, Department of Surgical, Microsurgical, and Medical Sciences, University of Sassari, Sassari - Italy.

Purpose: Toxic epidermal necrolysis (TEN) is a rare, life-threatening, drug-induced, mucocutaneous disease, which can severely affect the ocular surface. The purpose of this study was to investigate the efficacy of plasmapheresis, human IV immunoglobulins (IVIg), and autologous serum (AS) eyedrops in the treatment of the severe acute ocular complications of TEN.

Methods: A retrospective chart review of all patients admitted to the Burn Unit, Azienda Ospedaliero-Universitaria-Sassari, Sassari, Italy, from 2009 to 2015, identified 9 patients (2 men, 7 women; mean age 63. Read More

An Bras Dermatol 2016 Sep-Oct;91(5 suppl 1):35-38

Universidade Federal de São Paulo (Unifesp) - São Paulo (SP), Brazil.

Linear IgA dermatosis is a rare subepidermal autoimmune blistering disease characterized by linear deposition of IgA along the basement membrane zone. In the last three decades, many different drugs have been associated with the drug-induced form of the disease, especially vancomycin. We report a case of vancomycin-induced linear IgA disease mimicking toxic epidermal necrolysis. Read More

J Dermatol 2017 Jul 11;44(7):818-821. Epub 2017 Mar 11.

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

Vemurafenib improves survival of melanoma patients. However, cutaneous side-effects commonly occur in them. Nivolumab and ipilimumab are monoclonal antibodies against programmed death 1 and cytotoxic T-lymphocyte-associated antigen 4, both of which regulate excessive T-cell activation. Read More

Clin Pharmacol Ther 2017 07 3;102(1):86-97. Epub 2017 Jun 3.

Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Linkou, Taiwan.

Cutaneous idiosyncratic drug reactions (CIDRs) are usually unpredictable, ranging from mild maculopapular exanthema (MPE) to severe cutaneous adverse drug reactions (SCARs) such as drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). Increasing evidence suggests that HLA alleles are strongly associated with drug-induced-CIDRs. The pathomechanisms for CIDRs include genetic polymorphisms affecting complex immune-specific HLA/drug antigen/T-cell receptor interactions and drug metabolism. Read More

J Nippon Med Sch 2016 ;83(6):216-222

Department of Dermatology, Nippon Medical School.

Toxic epidermal necrolysis (TEN) is a rare skin condition, most often drug-induced, known for its skin detachment and high mortality. In general, acute TEN is considered a T-cell mediated, type IV hypersensitivity disorder. It mostly results from a cumulative effect of risks from the drug structure, drug metabolism, HLA alleles and T cell clonotypes. Read More

Clin Exp Dermatol 2017 Apr 13;42(3):299-302. Epub 2017 Jan 13.

Department of Dermatology, Alfred Hospital, Melbourne, VIC, Australia.

Linear IgA bullous dermatosis (LABD) is a subepidermal autoimmune bullous disease characterized by linear IgA deposition at the basement membrane zone, which is visualized by direct immunofluorescence. Patients with LABD typically present with widespread vesicles and bullae; however, this is not necessarily the case, as the clinical presentation of this disease is heterogeneous. LABD clinically presenting as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) is an infrequent, yet well-described phenomenon. Read More

Int J Mol Sci 2016 Dec 18;17(12). Epub 2016 Dec 18.

Dermatology Department, Royal North Shore Hospital, 2065 Sydney, Australia.

Toxic epidermal necrolysis (TEN) is a rare but life threatening mucocutaneous reaction to drugs or their metabolites. It is characterised by widespread keratinocyte apoptosis and sloughing of the skin, erosions of the mucous membranes, painful blistering, and severe systemic disturbance. The pathophysiology of TEN is incompletely understood. Read More

Clin Dermatol 2016 Nov - Dec;34(6):724-735. Epub 2016 Jul 12.

University of Connecticut School of Medicine, Department of Dermatology, Farmington, CT.

Photodermatoses are a group of skin disorders caused by abnormal reaction to ultraviolet radiation. Photodermatoses are divided into four groups: (1) immunologically mediated photodermatoses; (2) chemical- and drug-induced photodermatoses; (3) photoaggravated dermatoses; and (4) hereditary photodermatoses. This contribution discusses differences in the approach and diagnosis of pediatric and adult patients with suspected photodermatoses, focusing on immunologically mediated photodermatoses and chemical- and drug-induced photodermatoses. Read More

Clin Dermatol 2017 Jan - Feb;35(1):55-63. Epub 2016 Sep 10.

Department of Dermatology, Second University of Naples, Naples, Italy.

Drug reactions and systemic diseases often involve the skin. In particular, most drug-induced reactions and many infectious diseases present with dermatologic manifestations localized acrally, that is on distal portions of limbs (hand, foot) and head (ears, nose). A detailed review of all acral dermatologic signs of drug reactions and systemic diseases is beyond the scope of this paper, although some of these disorders will be discussed specifically here. Read More

Prescrire Int 2016 Dec;25(177):289-292

Existing drugs are poorly effective in patients with inoperable or meta- static melanoma without a mutation in the BRAF gene at position V600. The first-line treatment of choice for patients with BRAF V600-positive melanoma is a combination of dabrafenib (a BRAF inhibitor) and trametinib. Nivolumab is a human monoclonal antibody designed to block receptors for PD-1 (programmed cell death-1) and thus to enhance T lymphocyte activity, especially against tumour cells. Read More

PLoS One 2016 29;11(11):e0167402. Epub 2016 Nov 29.

Division of Medical Safety Science, National Institute of Health Sciences, Setagaya, Tokyo, Japan.

Stevens-Johnson syndrome (SJS) and its severe variant, toxic epidermal necrolysis (TEN), are drug-induced acute inflammatory vesiculobullous reactions of the skin and mucous membranes, including the ocular surface. Even after recovery from skin symptoms, some SJS/TEN patients continue to suffer with severe ocular complications (SOCs). Therefore, this study aims to understand the pathophysiology of chronic SOCs. Read More

Dermatol Ther 2017 Mar 18;30(2). Epub 2016 Nov 18.

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

Recurrent erythema multiforme (REM) is a chronic disease characterized by frequent episodes of target cutaneous lesions in an acral distribution. Conventional treatment includes systemic corticosteroids and antiviral therapy. The aim of this study was to evaluate dapsone as a potential steroid sparing-agent for the treatment of REM after a failed trial of at least one antiviral therapy (acyclovir, famciclovir, or valacyclovir). Read More

Br J Dermatol 2016 Nov 29;175(5):994-1002. Epub 2016 Aug 29.

Division of Dermatology, Department of Medicine, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand.

Background: Allopurinol is a frequent cause of severe cutaneous adverse reactions (SCARs), such as drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The reactions can potentially be fatal. As drug rechallenge in patients with a history of drug-induced SCARs is contraindicated, in vitro testing may have a diagnostic role as a confirmation test. Read More