Medication Summary
Therapy for most drug eruptions is mainly supportive in nature. Morbilliform eruptions are treated with oral antihistamines and topical steroids. IVIG is currently the most common agent used to treat TEN. Cyclosporine may also have a role in the treatment of TEN. Prednisone may be used in the treatment of hypersensitivity syndrome with heart and lung involvement, severe serum sickness–like reaction, and Sweet syndrome.
First-generation antihistamines
Class Summary
These agents antagonize H1 receptors and block release of histamine. They provide symptomatic relief of pruritus and help improve eruptions.
Hydroxyzine HCl (Anxanil, Atarax, Atozine, Durrax, Vistaril)
Hydroxyzine antagonizes H1 receptors in the periphery. It may suppress histamine activity in the subcortical CNS. Hydroxyzine is available as 10-, 25-, 50-, or 100-mg tablets.
Diphenhydramine HCl (Benadryl, Benylin, Diphen, AllerMax)
Diphenhydramine is used for symptomatic relief of allergic symptoms caused by the release of histamine in immune reactions.
Second-generation antihistamines, nonsedating
Class Summary
These agents cause less, if any, drowsiness than first-generation agents.
Loratadine (Claritin)
Loratadine selectively inhibits peripheral histamine H1 receptors.
Corticosteroids
Class Summary
Topical agents provide symptomatic relief of pruritus. Systemic steroids are used in persons with hypersensitivity syndrome, severe serum sickness–like reactions, and Sweet syndrome.
Desonide
Desonide is for inflammatory dermatoses responsive to steroids; it decreases inflammation by suppressing the migration of PMN leukocytes and reversing capillary permeability.
Prednisone (Deltasone, Orasone, Sterapred)
Prednisone is an immunosuppressant for the treatment of immune disorders; it may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity; it is available in 2.5-, 5-, 10-, 20-, or 50-mg tablets.
Immunoglobulins
Class Summary
These agents are used to treat TEN.
Intravenous immunoglobulin (Gammagard, Gamimune)
Intravenous immunoglobulin is a blood product prepared from the pooled plasma of healthy donors. The following features are possibly relevant to efficacy: neutralization of circulating myelin antibodies through anti-idiotypic antibodies; down-regulation of proinflammatory cytokines, including IFN-gamma; blockade of Fc receptors on macrophages; suppression of inducer T and B cells and augmentation of T-suppressor cells; blockade of complement cascade; promotion of remyelination; and 10% increase in CSF IgG.
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Morbilliform drug eruption.
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Warfarin (Coumadin) necrosis involving the leg.
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Toxic epidermal necrolysis.
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Stevens-Johnson syndrome.
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Erythroderma.
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Erythema multiforme.
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Fixed drug eruption.
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Fixed drug eruption involving the penis.
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Oral ulcerations in a patient receiving cytotoxic therapy.
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Phototoxic reaction after use of a tanning booth. Note sharp cutoff where clothing blocked exposure.
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Vasculitic reaction on the legs.
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Lichen planus on the neck.
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Steroid acne. Note pustules and absence of comedones.
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Drug reaction to hydroxychloroquine (Plaquenil).
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Urticaria.
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Erythema nodosum.
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Confluent necrosis of the epidermis in toxic epidermal necrolysis.
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Perivascular mixed inflammatory infiltrate with eosinophils characteristic of drug-induced urticaria.
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Biopsy of pseudoporphyria shows a subepidermal blister with little to no inflammation.
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Confluent necrosis of the epidermis in toxic epidermal necrolysis.
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Superficial perivascular inflammatory infiltrate with numerous eosinophils characteristic of an exanthematous drug eruption.
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Target lesions of erythema multiforme.
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Papules and annular plaques.
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Superficial and mid-dermal perivascular infiltrate of lymphocytes and eosinophils. Foci of extravasation of erythrocytes.
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Numerous milia in a patient treated with vemurafenib.
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Dilated infundibular cyst.
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Paronychia.
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Male-pattern diffuse hair loss.
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Pink/fleshy perifollicular papules with diffuse alopecia.
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Horizontal section shows perifollicular fibrosis consistent with scarring alopecia.