Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Drug-Induced Bullous Disorders Treatment & Management

  • Author: David F Butler, MD; Chief Editor: William D James, MD  more...
 
Updated: Mar 29, 2016
 

Medical Care

Withdrawal of the offending medication is the most important aspect of treatment of bullous drug reactions. Most reactions are self-limited. Conservative treatment of these disorders involves using wet compresses of Burrow solution and the application of moderate- to high-potency topical corticosteroids. More severe reactions may require the use of systemic corticosteroids.

The use of corticosteroids in the treatment of SJS and TEN is controversial. Patients with SJS and TEN are usually managed as inpatients in the intensive care or burn units. Fluid hydration, electrolyte balance, and nutritional support are the cornerstones of therapy. Rigorously guard against infection. Intravenous gamma globulin (IVIG) shows promise in the treatment of TEN. The IVIG reduces apoptosis by blocking CD95 on T cells.[33] In TEN, early withdrawal of precipitating drugs may reduce mortality if the drug has a short half-life.[34]

Next

Consultations

Limited forms of EM can be managed on an outpatient basis; however, careful consideration should be given to patients with SJS and TEN regarding an early referral to an intensive care unit or preferably a burn unit. Eye involvement that can occur in EM, SJS, and TEN requires an ophthalmologic evaluation.

Previous
Next

Prevention

Avoid use of the offending drug.

Previous
 
Contributor Information and Disclosures
Author

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Ponciano D Cruz, Jr, MD Professor and Vice-Chair, Paul R Bergstresser Chair, Department of Dermatology, University of Texas Southwestern Medical Center

Ponciano D Cruz, Jr, MD is a member of the following medical societies: Texas Medical Association

Disclosure: Received consulting fee from RCTS for independent contractor; Received honoraria from Mary Kay Cosmetics for consulting; Received grant/research funds from Galderma for principal investigator.

References
  1. Fortuna G, Salas-Alanis JC, Guidetti E, Marinkovich MP. A critical reappraisal of the current data on drug-induced linear immuglobulin A bullous dermatosis: A real and separate nosological entity?. J Am Acad Dermatol. 2011 Dec 9. [Medline].

  2. Gumaste PV, Cohen DE, Stein JA. Bullous Systemic Contact Dermatitis Caused by an Intra-articular Steroid Injection. Br J Dermatol. 2014 Jul 12. [Medline].

  3. Miyamoto J, Böckle BC, Zillikens D, Schmidt E, Schmuth M. Eczematous reaction to intravenous immunoglobulin: an alternative cause of eczema. JAMA Dermatol. 2014 Oct. 150 (10):1120-2. [Medline].

  4. Pernet C, Guillot B, Bessis D. Eczematous drug eruption after ustekinumab treatment. Arch Dermatol. 2012 Aug. 148 (8):959-60. [Medline].

  5. Hausermann P, Scherer K, Weber M, Bircher AJ. Ciprofloxacin-induced acute generalized exanthematous pustulosis mimicking bullous drug eruption confirmed by a positive patch test. Dermatology. 2005. 211(3):277-80. [Medline].

  6. Noce R, Paredes BE, Pichler WJ, Krähenbühl S. Acute generalized exanthematic pustulosis (AGEP) in a patient treated with furosemide. Am J Med Sci. 2000 Nov. 320(5):331-3. [Medline].

  7. Kubin ME, Jackson P, Riekki R. Acute Generalized Exanthematous Pustulosis Secondary to Acyclovir Confirmed by Positive Patch Testing. Acta Derm Venereol. 2016 Feb 2. [Medline].

  8. Charfi O, Kastalli S, Sahnoun R, Lakhoua G. Hydroxychloroquine-induced acute generalized exanthematous pustulosis with positive patch-testing. Indian J Pharmacol. 2015 Nov-Dec. 47 (6):693-4. [Medline].

  9. Wei CY, Ko TM, Shen CY, Chen YT. A Recent Update of Pharmacogenomics in Drug-Induced Severe Skin Reactions. Drug Metab Pharmacokinet. 2011 Nov 1. [Medline].

  10. Handisurya A, Moritz KB, Riedl E, Reinisch C, Stingl G, Wöhrl S. Fixed drug eruption caused by mefenamic acid: a case series and diagnostic algorithms. J Dtsch Dermatol Ges. 2011 May. 9(5):374-8. [Medline].

  11. Khaldi N, Miras A, Gromb S. Toxic epidermal necrolysis and clarithromycin. Can J Clin Pharmacol. 2005 Fall. 12(3):e264-8. [Medline].

  12. Jongen-Lavrencic M, Schneeberger PM, van der Hoeven JG. Ciprofloxacin-induced toxic epidermal necrolysis in a patient with systemic lupus erythematosus. Infection. 2003 Dec. 31(6):428-9. [Medline].

  13. Dyson SW, Lin C, Jaworsky C. Enoxaparin sodium-induced bullous pemphigoid-like eruption: a report of 2 cases. J Am Acad Dermatol. 2004 Jul. 51(1):141-2. [Medline].

  14. Leivo T, Heikkilä H. Naproxen-induced generalized bullous fixed drug eruption. Br J Dermatol. 2004 Jul. 151(1):232. [Medline].

  15. Layton D, Marshall V, Boshier A, Friedmann P, Shakir SA. Serious skin reactions and selective COX-2 inhibitors: a case series from prescription-event monitoring in England. Drug Saf. 2006. 29(8):687-96. [Medline].

  16. Pitsios C. Erythema multiforme caused by sildenafil in an HIV(+) subject. Eur Ann Allergy Clin Immunol. 2016 Mar. 48 (2):58-60. [Medline].

  17. Freed J, Wells M, Stetson C, Dongwoo L. Bullous reaction to topical methchlorethamine in mycosis fungoides. J Drugs Dermatol. 2006 Jan. 5(1):66-7. [Medline].

  18. Werchniak AE, Chaffee S, Dinulos JG. Methotrexate-induced bullous acral erythema in a child. J Am Acad Dermatol. 2005 May. 52(5 Suppl 1):S93-5. [Medline].

  19. Korman NJ, Eyre RW, Zone J, Stanley JR. Drug-induced pemphigus: autoantibodies directed against the pemphigus antigen complexes are present in penicillamine and captopril-induced pemphigus. J Invest Dermatol. 1991 Feb. 96(2):273-6. [Medline].

  20. Pinto GM, Lamarao P, Vale T. Captopril-induced pemphigus vegetans with Charcot-Leyden crystals. J Am Acad Dermatol. 1992 Aug. 27(2 Pt 2):281-4. [Medline].

  21. Ben Salem C, Chenguel L, Ghariani N, Denguezli M, Hmouda H, Bouraoui K. Captopril-induced lichen planus pemphigoides. Pharmacoepidemiol Drug Saf. 2008 Jul. 17(7):722-4. [Medline].

  22. Perry A, Sparling JD, Pennington M. Bullous pemphigoid following therapy with an oral beta-blocker. J Drugs Dermatol. 2005 Nov-Dec. 4(6):746-8. [Medline].

  23. Atzori L, Conti B, Zucca M, Pau M. Bullous pemphigoid induced by m-TOR inhibitors in renal transplant recipients. J Eur Acad Dermatol Venereol. 2014 Aug 29. [Medline].

  24. Aksakal BA, Ozsoy E, Arnavut O, Ali Gurer M. Oral terbinafine-induced bullous pemphigoid. Ann Pharmacother. 2003 Nov. 37(11):1625-7. [Medline].

  25. Carpenter S, Berg D, Sidhu-Malik N, Hall RP 3rd, Rico MJ. Vancomycin-associated linear IgA dermatosis. A report of three cases. J Am Acad Dermatol. 1992 Jan. 26(1):45-8. [Medline].

  26. Waldman MA, Black DR, Callen JP. Vancomycin-induced linear IgA bullous disease presenting as toxic epidermal necrolysis. Clin Exp Dermatol. 2004 Nov. 29(6):633-6. [Medline].

  27. Whitworth JM, Thomas I, Peltz SA, Sullivan BC, Wolf AH, Cytryn AS. Vancomycin-induced linear IgA bullous dermatosis (LABD). J Am Acad Dermatol. 1996 May. 34(5 Pt 2):890-1. [Medline].

  28. Santos-Juanes J, Coto Hernandez R, Trapiella L, Caminal L, Sanchez del Rio J, Soto J. Amoxicillin-associated linear IgA bullous dermatosis. J Eur Acad Dermatol Venereol. 2007 Aug. 21(7):992-3. [Medline].

  29. Shimanovich I, Rose C, Sitaru C, Brocker EB, Zillikens D. Localized linear IgA disease induced by ampicillin/sulbactam. J Am Acad Dermatol. 2004 Jul. 51(1):95-8. [Medline].

  30. Hernández N, Borrego L, Soler E, Hernández J. Sulfasalazine-induced linear immunoglobulin A bullous dermatosis with DRESS. Actas Dermosifiliogr. 2013 May. 104(4):343-6. [Medline].

  31. Tolland JP, McKeown PP, Corbett JR. Voriconazole-induced pseudoporphyria. Photodermatol Photoimmunol Photomed. 2007 Feb. 23(1):29-31. [Medline].

  32. Hofmann M, Audring H, Sterry W, Trefzer U. Interleukin-2-associated bullous drug dermatosis. Dermatology. 2005. 210(1):74-5. [Medline].

  33. Viard I, Wehrli P, Bullani R, Schneider P, Holler N, Salomon D, et al. Inhibition of toxic epidermal necrolysis by blockade of CD95 with human intravenous immunoglobulin. Science. 1998 Oct 16. 282(5388):490-3. [Medline].

  34. Garcia-Doval I, LeCleach L, Bocquet H, Otero XL, Roujeau JC. Toxic epidermal necrolysis and Stevens-Johnson syndrome: does early withdrawal of causative drugs decrease the risk of death?. Arch Dermatol. 2000 Mar. 136(3):323-7. [Medline].

Previous
Next
 
Small pustules on erythematous patch (acute generalized exanthematous pustulosis).
Annular hyperpigmented patch (fixed drug eruption).
Target or iris lesions on palm (erythema multiforme).
Coalescing eroded patches (Stevens-Johnson syndrome).
Stevens-Johnson syndrome.
Crusted erosions on scalp (drug-induced pemphigus).
Small vesicle at edge of urticarial plaque (drug-induced pemphigoid).
Tense vesicles in annular array (linear immunoglobulin A dermatosis).
Erosions, scars, milia, and vesicle (pseudoporphyria).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.