Drug Eruptions Differential Diagnoses

  • Author: Jonathan E Blume, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 15, 2012
 
 

Differential Diagnoses

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Contributor Information and Disclosures
Author

Jonathan E Blume, MD  Instructor in Clinical Dermatology, Columbia University College of Physicians and Surgeons; Dermatologist, Westwood Dermatology and Dermatologic Surgery Group PA

Jonathan E Blume, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, and International Society of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Liaqat Ali, MD  Fellow, Division of Dermatopathology, Department of Dermatology and Pathology, Pennsylvania State University College of Medicine

Liaqat Ali, MD is a member of the following medical societies: American Society for Clinical Pathology, American Society of Dermatopathology, College of American Pathologists, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Michelle Ehrlich, MD  Director of Cosmetic Dermatology and Surgery Residency Program, Harbor-UCLA Medical Center; Clinical Instructor, Department of Dermatology, University of California, Los Angeles, David Geffen School of Medicine

Michelle Ehrlich, MD is a member of the following medical societies: American Academy of Cosmetic Surgery and American Academy of Dermatology

Disclosure: Nothing to disclose.

Charles Camisa, MD  Head of Clinical Dermatology, Vice-Chair, Department of Dermatology, Cleveland Clinic Foundation

Charles Camisa, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Thomas N Helm, MD  Clinical Professor of Dermatology and Pathology, University of Buffalo, State University of New York School of Medicine and Biomedical Sciences; Director, Buffalo Medical Group Dermatopathology Laboratory

Thomas N Helm, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for Dermatologic Surgery, and American Society of Dermatopathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Neil Shear, MD  Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Women's College Health Sciences Center and Women's College Hospital, Canada

Neil Shear, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics, Canadian Dermatology Association, Canadian Medical Association, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD  Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Celgene Honoraria Safety Monitoring Committee

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Iannini P, Mandell L, Felmingham J, Patou G, Tillotson GS. Adverse cutaneous reactions and drugs: a focus on antimicrobials. J Chemother. Apr 2006;18(2):127-39. [Medline].

  2. Green JJ, Manders SM. Pseudoporphyria. J Am Acad Dermatol. Jan 2001;44(1):100-8. [Medline].

  3. Coopman SA, Johnson RA, Platt R, Stern RS. Cutaneous disease and drug reactions in HIV infection. N Engl J Med. Jun 10 1993;328(23):1670-4. [Medline].

  4. Taddio A, Lee CM, Parvez B, Koren G, Shah V. Contact dermatitis and bradycardia in a preterm infant given tetracaine 4% gel. Ther Drug Monit. 2006 Jun; 28(3):291-4. Available at http://www.ncbi.nlm.nih.gov/pubmed/16778708.

  5. Thakor P, Padmanabhan M, Johnson A, Pararajasingam T, Thakor S, Jorgensen W. Ramipril-induced generalized pustular psoriasis: case report and literature review. Available at http://www.ncbi.nlm.nih.gov/sites/entrez/19531936.

  6. Dacey MJ, Callen JP. Hydroxyurea-induced dermatomyositis-like eruption. J Am Acad Dermatol. Mar 2003;48(3):439-41. [Medline].

  7. Nofal A, El-Din ES. Hydroxyurea-induced dermatomyositis: true amyopathic dermatomyositis or dermatomyositis-like eruption?. Int J Dermatol. May 2012;51(5):535-41. [Medline].

  8. Shaughnessy KK, Bouchard SM, Mohr MR, Herre JM, Salkey KS. Minocycline-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome with persistent myocarditis. J Am Acad Dermatol. 2010 Feb; 62 (2):315-8. Available at http://www.ncbi.nlm.nih.gov/pubmed/19665822..

  9. Ellgehausen P, Elsner P, Burg G. Drug-induced lichen planus. Clin Dermatol. May-Jun 1998;16(3):325-32. [Medline].

  10. Camilleri M, Pace JL. Drug-induced linear immunoglobulin-A bullous dermatosis. Clin Dermatol. May-Jun 1998;16(3):389-91. [Medline].

  11. Antonov D, Kazandjieva J, Etugov D, Gospodinov D, Tsankov N. Drug-induced lupus erythematosus. Clin Dermatol. Mar-Apr 2004;22(2):157-66. [Medline].

  12. Brenner S, Bialy-Golan A, Ruocco V. Drug-induced pemphigus. Clin Dermatol. May-Jun 1998;16(3):393-7. [Medline].

  13. Brauchli YB, Jick SS, Curtin F, Meier CR. Association between beta-blockers, other antihypertensive drugs and psoriasis: population-based case-control study. Br J Dermatol. Jun 2008;158(6):1299-307. [Medline].

  14. Dika E, Varotti C, Bardazzi F, Maibach HI. Drug-induced psoriasis: an evidence-based overview and the introduction of psoriatic drug eruption probability score. Cutan Ocul Toxicol. 2006;25(1):1-11. [Medline].

  15. Tsankov N, Angelova I, Kazandjieva J. Drug-induced psoriasis. Recognition and management. Am J Clin Dermatol. May-Jun 2000;1(3):159-65. [Medline].

  16. Clark BM, Kotti GH, Shah AD, Conger NG. Severe serum sickness reaction to oral and intramuscular penicillin. Pharmacotherapy. May 2006;26(5):705-8. [Medline].

  17. Hazin R, Ibrahimi OA, Hazin MI, Kimyai-Asadi A. Stevens-Johnson syndrome: pathogenesis, diagnosis, and management. Ann Med. 2008;40(2):129-38. [Medline].

  18. Lee HY, Pang SM, Thamotharampillai T. Allopurinol-induced Stevens-Johnson syndrome and toxic epidermal necrolysis. J Am Acad Dermatol. Aug 2008;59(2):352-3. [Medline].

  19. Roujeau JC, Kelly JP, Naldi L, et al. Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. N Engl J Med. Dec 14 1995;333(24):1600-7. [Medline].

  20. Singer JP, Boker A, Metchnikoff C, et al. High cumulative dose exposure to voriconazole is associated with cutaneous squamous cell carcinoma in lung transplant recipients. J Heart Lung Transplant. Apr 6 2012;[Medline].

  21. Miller DD, Cowen EW, Nguyen JC, McCalmont TH, Fox LP. Melanoma associated with long-term voriconazole therapy: a new manifestation of chronic photosensitivity. Arch Dermatol. Mar 2010;146(3):300-4. [Medline].

  22. MacMorran WS, Krahn LE. Adverse cutaneous reactions to psychotropic drugs. Psychosomatics. Sep-Oct 1997;38(5):413-22. [Medline].

  23. Roe E, Garcia Muret MP, Marcuello E, Capdevila J, Pallares C, Alomar A. Description and management of cutaneous side effects during cetuximab or erlotinib treatments: a prospective study of 30 patients. J Am Acad Dermatol. Sep 2006;55(3):429-37. [Medline].

  24. Graves JE, Jones BF, Lind AC, Heffernan MP. Nonscarring inflammatory alopecia associated with the epidermal growth factor receptor inhibitor gefitinib. J Am Acad Dermatol. Aug 2006;55(2):349-53. [Medline].

  25. Donovan JC, Ghazarian DM, Shaw JC. Scarring alopecia associated with use of the epidermal growth factor receptor inhibitor gefitinib. Arch Dermatol. Nov 2008;144(11):1524-5. [Medline].

  26. Shipley D, Ormerod AD. Drug-induced urticaria. Recognition and treatment. Am J Clin Dermatol. 2001;2(3):151-8. [Medline].

  27. Heidary N, Naik H, Burgin S. Chemotherapeutic agents and the skin: An update. J Am Acad Dermatol. Apr 2008;58(4):545-70. [Medline].

  28. Wu PA, Balagula Y, Lacouture ME, Anadkat MJ. Prophylaxis and treatment of dermatologic adverse events from epidermal growth factor receptor inhibitors. Curr Opin Oncol. Jul 2011;23(4):343-51. [Medline].

  29. Autier J, Escudier B, Wechsler J, Spatz A, Robert C. Prospective study of the cutaneous adverse effects of sorafenib, a novel multikinase inhibitor. Medline. Available at http://www.ncbi.nlm.nih.gov/sites/entrez/18645140.

  30. Sosman JA, Kim KB, Schuchter L, et al. Survival in BRAF V600-mutant advanced melanoma treated with vemurafenib. N Engl J Med. Feb 23 2012;366(8):707-14. [Medline].

  31. Harding JJ, Pulitzer M, Chapman PB. Vemurafenib sensitivity skin reaction after ipilimumab. N Engl J Med. Mar 1 2012;366(9):866-8. [Medline].

  32. Teoh DC, Aw DC, Jaffar H, et al. Tamoxifen-induced eccrine squamous syringometaplasia. J Cutan Pathol. May 2012;39(5):554-7. [Medline].

  33. Asnis LA, Gaspari AA. Cutaneous reactions to recombinant cytokine therapy. J Am Acad Dermatol. Sep 1995;33(3):393-410; quiz 410-2. [Medline].

  34. Hawryluk EB, Linskey KR, Duncan LM, Nazarian RM. Broad range of adverse cutaneous eruptions in patients on TNF-alpha antagonists. J Cutan Pathol. May 2012;39(5):481-92. [Medline].

  35. Papp KA, Langley RG, Lebwohl M, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 52-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 2). Medline. Available at http://www.ncbi.nlm.nih.gov/sites/entrez/18486740.

  36. Barbaud A. Drug patch testing in systemic cutaneous drug allergy. Toxicology. Apr 15 2005;209(2):209-16. [Medline].

  37. French LE, Trent JT, Kerdel FA. Use of intravenous immunoglobulin in toxic epidermal necrolysis and Stevens-Johnson syndrome: our current understanding. Int Immunopharmacol. Apr 2006;6(4):543-9. [Medline].

  38. Mukasa Y, Craven N. Management of toxic epidermal necrolysis and related syndromes. Postgrad Med J. Feb 2008;84(988):60-5. [Medline].

  39. Paquet P, Pierard GE, Quatresooz P. Novel treatments for drug-induced toxic epidermal necrolysis (Lyell's syndrome). Int Arch Allergy Immunol. Mar 2005;136(3):205-16. [Medline].

  40. Bork K. Adverse drug reactions. In: Demis DJ, ed. Clinical Dermatology. Vol 3. Philadelphia, Pa: Lippincott-Raven; 1998.

  41. Breathnach SM, Hintner H. Adverse Drug Reactions and the Skin. London, England: Blackwell Scientific; 1992.

  42. Campos-Fernandez Mdel M, Ponce-De-Leon-Rosales S, Archer-Dubon C, Orozco-Topete R. Incidence and risk factors for cutaneous adverse drug reactions in an intensive care unit. Rev Invest Clin. Nov-Dec 2005;57(6):770-4. [Medline].

  43. Coombs RRA, Gell PGH. Classification of allergic reactions responsible for clinical hypersensitivity and disease. Clin Aspects Immunol. 1968;575-96.

  44. Daoud MS, Schanbacher CF, Dicken CH. Recognizing cutaneous drug eruptions. Reaction patterns provide clues to causes. Postgrad Med. Jul 1998;104(1):101-4, 107-8, 114-5. [Medline].

  45. Fitzpatrick JE. New histopathologic findings in drug eruptions. Dermatol Clin. Jan 1992;10(1):19-36. [Medline].

  46. Gendernalik SB, Galeckas KJ. Fixed drug eruptions: a case report and review of the literature. Cutis. Oct 2009;84(4):215-9. [Medline].

  47. Greenberger PA. 8. Drug allergy. J Allergy Clin Immunol. Feb 2006;117(2 Suppl Mini-Primer):S464-70. [Medline].

  48. Hunziker T, Kunzi UP, Braunschweig S, Zehnder D, Hoigne R. Comprehensive hospital drug monitoring (CHDM): adverse skin reactions, a 20-year survey. Allergy. Apr 1997;52(4):388-93. [Medline].

  49. Keet I, Meyaard L, Boucher E, et al. Allergic reactions to cotrimoxazole correlate with decreased T-cell reactivity compatible with a Th1 to Th2 shift [abstr PO-A19-0404]. Int Conf AIDS. 1993;9 (1):202.

  50. Kramer MS, Leventhal JM, Hutchinson TA, Feinstein AR. An algorithm for the operational assessment of adverse drug reactions. I. Background, description, and instructions for use. JAMA. Aug 17 1979;242(7):623-32. [Medline].

  51. Lerch M, Pichler WJ. The immunological and clinical spectrum of delayed drug-induced exanthems. Curr Opin Allergy Clin Immunol. Oct 2004;4(5):411-9. [Medline].

  52. Litt JZ. Drug Eruption Reference Manual 2002. New York, NY: Parthenon; 2002.

  53. Mayorga C, Pena RR, Blanca-Lopez N, Lopez S, Martin E, Torres MJ. Monitoring the acute phase response in non-immediate allergic drug reactions. Curr Opin Allergy Clin Immunol. Aug 2006;6(4):249-57. [Medline].

  54. McKenna JK, Leiferman KM. Dermatologic drug reactions. Immunol Allergy Clin North Am. Aug 2004;24(3):399-423, vi. [Medline].

  55. Mockenhaupt M, Schopf E. Epidemiology of drug-induced severe skin reactions. Semin Cutan Med Surg. Dec 1996;15(4):236-43. [Medline].

  56. Nigen S, Knowles SR, Shear NH. Drug eruptions: approaching the diagnosis of drug-induced skin diseases. J Drugs Dermatol. Jun 2003;2(3):278-99. [Medline].

  57. Pereira FA, Mudgil AV, Rosmarin DM. Toxic epidermal necrolysis. J Am Acad Dermatol. Feb 2007;56(2):181-200. [Medline].

  58. Revuz J, Valeyrie-Allanore L. Drug reactions. In: Dermatology. Vol 1. Philadelphia, Pa: Mosby; 2003:333-53.

  59. Roujeau JC, Bioulac-Sage P, Bourseau C, et al. Acute generalized exanthematous pustulosis. Analysis of 63 cases. Arch Dermatol. Sep 1991;127(9):1333-8. [Medline].

  60. Sahin S, Comert A, Akin O, Ayalp S, Karsidag S. Cutaneous drug eruptions by current antiepileptics: case reports and alternative treatment options. Clin Neuropharmacol. Mar-Apr 2008;31(2):93-6. [Medline].

  61. Shapiro LE, Shear NH. Mechanisms of drug reactions: the metabolic track. Semin Cutan Med Surg. Dec 1996;15(4):217-27. [Medline].

  62. Stern RS, Steinberg LA. Epidemiology of adverse cutaneous reactions to drugs. Dermatol Clin. Jul 1995;13(3):681-8. [Medline].

  63. Susser WS, Whitaker-Worth DL, Grant-Kels JM. Mucocutaneous reactions to chemotherapy. J Am Acad Dermatol. Mar 1999;40(3):367-98; quiz 399-400. [Medline].

  64. Ward HA, Russo GG, Shrum J. Cutaneous manifestations of antiretroviral therapy. J Am Acad Dermatol. Feb 2002;46(2):284-93. [Medline].

  65. Ward KE, Archambault R, Mersfelder TL. Severe adverse skin reactions to nonsteroidal antiinflammatory drugs: A review of the literature. Am J Health Syst Pharm. Feb 1 2010;67(3):206-13. [Medline].

  66. Warnock JK, Morris DW. Adverse cutaneous reactions to antidepressants. Am J Clin Dermatol. 2002;3(5):329-39. [Medline].

  67. Warnock JK, Morris DW. Adverse cutaneous reactions to mood stabilizers. Am J Clin Dermatol. 2003;4(1):21-30. [Medline].

  68. Wolf R, Orion E, Marcos B, Matz H. Life-threatening acute adverse cutaneous drug reactions. Clin Dermatol. Mar-Apr 2005;23(2):171-81. [Medline].

  69. Wolverton SE. Update on cutaneous drug reactions. Adv Dermatol. 1997;13:65-84. [Medline].

  70. Wyatt AJ, Leonard GD, Sachs DL. Cutaneous reactions to chemotherapy and their management. Am J Clin Dermatol. 2006;7(1):45-63. [Medline].

 
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Morbilliform drug eruption.
Warfarin (Coumadin) necrosis involving the leg.
Toxic epidermal necrolysis.
Stevens-Johnson syndrome.
Erythroderma.
Erythema multiforme.
Fixed drug eruption.
Fixed drug eruption involving the penis.
Oral ulcerations in a patient receiving cytotoxic therapy.
Phototoxic reaction after use of a tanning booth. Note sharp cutoff where clothing blocked exposure.
Vasculitic reaction on the legs.
Lichen planus on the neck.
Steroid acne. Note pustules and absence of comedones.
Drug reaction to hydroxychloroquine (Plaquenil).
Urticaria.
Erythema nodosum.
Confluent necrosis of the epidermis in toxic epidermal necrolysis.
Perivascular mixed inflammatory infiltrate with eosinophils characteristic of drug-induced urticaria.
Biopsy of pseudoporphyria shows a subepidermal blister with little to no inflammation.
Confluent necrosis of the epidermis in toxic epidermal necrolysis.
Superficial perivascular inflammatory infiltrate with numerous eosinophils characteristic of an exanthematous drug eruption.
Target lesions of erythema multiforme.
Papules and annular plaques.
Superficial and mid-dermal perivascular infiltrate of lymphocytes and eosinophils. Foci of extravasation of erythrocytes.
Numerous milia in a patient treated with vemurafenib.
Dilated infundibular cyst.
Paronychia.
Male-pattern diffuse hair loss.
Pink/fleshy perifollicular papules with diffuse alopecia.
Horizontal section shows perifollicular fibrosis consistent with scarring alopecia.
 
 
 
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