ALDEN has shown a good accuracy to assess drug causality compared to data obtained by pharmacovigilance method and casecontrol results of the EuroSCAR casecontrol analysis for drugs associated with TEN. Loss of normal vasoconstrictive function in the dermis, decreased sensitivity to the shivering reflex and extra cooling that comes from evaporation of the fluids leaking out of the weeping skin lesions all result in thermoregulatory dysfunction that can cause hypothermia or hyperthermia.6 The basal metabolic rate also is increased in patients with exfoliative dermatitis. Carrozzo M, Togliatto M, Gandolfo S. Erythema multiforme. An epidemiologic study from West Germany. By using this website, you agree to our Fritsch PO. Epidemiological studies on EM, SJS and TEN syndromes report different results, probably related to several biases, such as ethnical differences, diagnostic criteria and drug consumption patterns in different socio-economic systems. Google Scholar. Br J Dermatol. 2009;151(7):5145. Wetter DA, Camilleri MJ. . official website and that any information you provide is encrypted Options include use of PUVA light therapy, total-body electron beam irradiation, topical nitrogen mustard, systemic chemotherapy and extracorporeal photopheresis. MalaCards based summary: Exfoliative Dermatitis is related to holocarboxylase synthetase deficiency and dermatitis, and has symptoms including exanthema An important gene associated with Exfoliative Dermatitis is SPINK5 (Serine Peptidase Inhibitor Kazal Type 5). Article 2014;71(1):1956. Moreover Mawson A and colleagues hypothesized that the efficacy of plasmapheresis is able to reduce serum level of vitamin A. The drug level peaks after 1- 4 h in plasma after ingestion with 95% protein binding. Mayo Clin Proc. The authors wish to thank Dr. Gary White for the picture of EM showed in Fig. Talk to our Chatbot to narrow down your search. Ann Allergy Asthma Immunol. In particular, drug induced exfoliative dermatitis (ED) are a group of rare and more severe drug hypersensitivity reactions (DHR) involving skin and mucous membranes and usually occurring from days to several weeks after drug exposure [2]. . Some anti-seizure medicines have also been known to cause exfoliative dermatitis. J Am Acad Dermatol. The site is secure. Ko TM, et al. HLA DQB1* 0301 allele is involved in the susceptibility to erythema multiforme. Huang SH, et al. See this image and copyright information in PMC. 1993;129(1):926. Chung and colleagues found an high expression of this molecule in TEN blister fluid [39] and confirmed both in vitro and in vivo its dose-dependent cytotoxicity [39]. Tohyama M, et al. The most commonly used steroids were methylprednisolone, prednisolone and dexamethasone. Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Orton PW, et al. Clin Mol Allergy 14, 9 (2016). TEN is characterized by full-thickness epidermal necrosis with an evident epidermal detachment and sloughing caused by necrosis of keratinocytes following apoptosis [49, 52]. 2014;81(1):1521. McCormack M, et al. More than moderate, unresponsive to treatment, and which interferes with the Soldier's perfor-mance of duty. Schwartz RA, McDonough PH, Lee BW. J Dermatol. Mona-Rita Yacoub. Tang YH, et al. Pharmacogenet Genom. Talk to our Chatbot to narrow down your search. Early enteral nutrition has also a protective effect on the intestinal mucosa and decreases bacterial colonization. 2015;64(3):2779. 2013;27(3):35664. Supportive and specific care includes both local and systemic measures, as represented in Fig. Article Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Erythroderma (literally, "red skin"), also sometimes called exfoliative dermatitis, is a severe and potentially life-threatening condition that presents with diffuse erythema and scaling involving all or most of the skin surface area (90 percent, in the most common definition). J Am Acad Dermatol. Pichler WJ, Tilch J. Erythema multiforme. Terms and Conditions, Neoplastic conditions (renal and gastric carcinoma), autoimmune disease (inflammatory bowel disease), HIV infection, radiation, and food additives/chemicals have been reported to be predisposing factor [59]. PubMed CAS StevensJohnson syndrome and toxic epidermal necrolysis: the Food and Drug Administration adverse event reporting system, 2004-2013. Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. In SJS, SJS/TEN and TEN the efficacy of corticosteroids is far from being demonstrated. Br J Dermatol. J Am Acad Dermatol. Severe Cutaneous Adverse Reactions: The Pharmacogenomics from Research to Clinical Implementation. 2012;13(1):4954. Ann Intern Med. 583-587. What are Drug Rashes? 2012;97:14966. Mawson AR, Eriator I, Karre S. StevensJohnson syndrome and toxic epidermal necrolysis (SJS/TEN): could retinoids play a causative role? 2011;20(2):10712. 2013;168(3):53949. Wolkenstein P, et al. Several authors report the incidence of hospitalization for EM ranging from 0.46 cases per million people per year of northern Europe [11] to almost 40 cases per million people per year of United States [12]. This content is owned by the AAFP. SSSS is characterized by periorificial face scabs, de-epithelialization of friction zones and conspicuous desquamation after initial erythroderma. Accurate eye cleaning with saline solution is fundamental for the prevention of synechiae and for reducing corneal damage. TEN is also known as Lyell syndrome, since it was first described by Alan Lyell in 1956 [2, 60]. Cutaneous drug eruptions are one of the most common types of adverse reaction to medications, with an overall incidence of 23% in hospitalized patients [1]. 1). Rheumatology (Oxford). More recently, carcinomas of the fallopian tube,12 larynx13 and esophagus14 have been reported as causes of exfoliative dermatitis. Herpes simplex virus (HSV) 1 and 2 are the main triggers in young adults (>80% of cases), followed by Epstein-Barr virus (EBV), and Mycoplasma pneumonia [5558]. Overall, T cells are the central player of these immune-mediated drug reactions. Incidence of toxic epidermal necrolysis and StevensJohnson Syndrome in an HIV cohort: an observational, retrospective case series study. . These levels could reflect the interaction between culprit drugs and aldehyde dehydrogenase that is the enzyme which metabolizes retinoid acid. A useful sign for differential diagnosis is the absence of mucosal involvement, except for conjunctiva. Retrospective review of StevensJohnson syndrome/toxic epidermal necrolysis treatment comparing intravenous immunoglobulin with cyclosporine. Important data on ED have been obtained by RegiSCAR (European Registry of Severe Cutaneous Adverse Reactions to Drugs: www.regiscar.org), an ongoing pharmaco-epidemiologic study conducted in patients with SJS and TEN. Erythroderma See more images of erythroderma. Antiviral therapy. Cookies policy. doi: 10.1111/dth.15416. Reticuloendothelial neoplasms, as well as internal visceral malignancies, can produce erythroderma, with the former being the more predominant cause. It is a reaction pattern and cutaneous manifestation of a myriad of underlying ailments, including psoriasis and eczema, or a reaction to the consumption of . 2001;108(5):83946. Background: Panitumumab is an EGFR inhibitor used for the treatment of metastatic colorectal cancer (mCRC), even if its use is related to skin toxicity. 2011;71(5):67283. Heat loss is another major concern that accompanies a defective skin barrier in patients with exfoliative dermatitis. 2002;109(1):15561. Hypersensitivity, Delayed Drug Hypersensitivity Radiodermatitis Drug Eruptions Skin Diseases Hypersensitivity Hand-Foot Syndrome Hypersensitivity, Immediate Dermatitis, Contact Erythema Foot Dermatoses Hand Dermatoses Skin Neoplasms Dermatitis, Allergic Contact Alveolitis, Extrinsic Allergic Acneiform Eruptions Dentin Sensitivity Dermatitis Other dermatoses associated with erythroderma are listed in Table 1.2,3,68. Curr Probl Dermatol. Clin Exp Dermatol. Overall, T cells are the central player of these immune-mediated drug reactions. PubMed It is important to take into consideration the mechanism of action of the different drugs in the pathogenesis of ED [104]. 2011;364(12):113443. Bastuji-Garin S, et al. Check the full list of possible causes and conditions now! Mortality rate of patients with TEN has shown to be directly correlated to SCORTEN. The serum levels of granulysin were also found to be increased in the early stage of SJS/TEN, but not in other cutaneous DHR [40]. The approach to treatment should include discontinuation of any potentially causative medications and a search for any underlying malignancy. Since the earliest descriptions of exfoliative dermatitis, medications have been known to be important causative agents. Toxic epidermal necrolysis: effector cells are drug-specific cytotoxic T cells. Descamps V, Ranger-Rogez S. DRESS syndrome. Here we provide a systematic review of frequency, risk factors, molecular and cellular mechanisms of reactions, clinical features, diagnostic work-up and therapy approaches to drug induced ED. Trautmann A, et al. 2008;58(1):3340. Drug induced exfoliative dermatitis: state of the art, https://doi.org/10.1186/s12948-016-0045-0, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. It is also extremely important to obtain within the first 24h cultural samples from skin together with blood, urine, nasal, pharyngeal and bronchus cultures. The dermis shows an inflammatory infiltrate characterized by a high-density lichenoid infiltrate rich in T cells (CD4+ more than CD8+) with macrophages, few neutrophils and occasional eosinophils; the latter especially seen in cases of DHR [5, 50]. 2010;37(10):9046. For these reasons, patients should be admitted to intensive burn care units or in semi-intensive care units where they may have access to sterile rooms and to dedicated medical personnel [49, 88]. 2013;57(4):58396. FDA Drug information Dupixent Read time: 6 mins Marketing start date: 04 Mar 2023 . Kostal M, et al. Br J Dermatol. In some studies, the nose and paranasal area are spared. [80], which consists of the determination of IFN and IL4 by ELISpot (Enzyme-linked immunospot assay), allowing to increase the sensitivity of LTT during acute DHR (82 versus 50% if compared to LPA). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Rabelink NM, Brakman M, Maartense E, Bril H, Bakker-Wensveen CA, Bavinck JN. Its also characterized by a cell-poor infiltrate, where macrophages and dendrocytes with a strong TNF- immunoreactivity predominate [6, 50]. Chan HL, et al. Clin Exp Dermatol. They found that the inhibition of these molecules could attenuate the cytotoxic effect of lymphocytes toward keratinocytes. 2005;62(4):63842. J Clin Apher. Fitzpatricks dermatology in general medicine. Drug induced exfoliative dermatitis (ED) are a group of rare and severe drug hypersensitivity reactions (DHR) involving skin and usually occurring from days to several weeks after drug exposure. A marker for StevensJohnson syndrome: ethnicity matters. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. 2007;56(5 Suppl):S1189. 2013;52(1):3444. Systemic derangements may occur with exfoliative. Even patients with clear histories of preexisting dermatoses tend to have biopsies that are not diagnostic when they present with erythroderma.2, Laboratory evaluation of patients with erythroderma is generally not very helpful in determining a specific diagnosis. The most notable member of this group is mycosis fungoides. The induction dosage in EMM is usually 1mg/kg/day that should be maintained until a complete control of the skin is obtained. 2002;146(4):7079. All non-indispensable drugs have to be stopped because they could alter the metabolism of the culprit agent. 19 Key critical interactions are discussed below for each mpox antiviral. Recurrent erythema multiforme: clinical characteristics, etiologic associations, and treatment in a series of 48 patients at Mayo Clinic, 2000 to 2007. See permissionsforcopyrightquestions and/or permission requests. The balance of fluids and electrolytes should be closely monitored, since dehydration or hypervolemia can be problems. Etoricoxib-induced toxic epidermal necrolysis: successful treatment with infliximab. Toxic epidermal necrolysis associated with Mycoplasma pneumoniae infection. Erythema multiforme (photo reproduced with permission of Gary White, MD): typical target lesions (white arrows) together with atypical two-zoned lesions (black arrows). Eur J Clin Microbiol Infect Dis. Paquet P, Pierard GE. J Eur Acad Dermatol Venereol. Exanthematous drug eruptions. A review of DRESS-associated myocarditis. Check the full list of possible causes and conditions now! Granulysin is a key mediator for disseminated keratinocyte death in StevensJohnson syndrome and toxic epidermal necrolysis. PubMed Downey A, et al. (2.4, 5.6) Embryo-fetal Toxicity: Can cause fetal harm. (sometimes fatal), erythema multiforme, Stevens-Johnson syndrome, exfoliative dermatitis, bullous dermatitis, drug rash with eosinophilia and systemic symptoms (DRESS . Therefore, the clinician should always consider drugs as a possible cause. Clinical practice. [Erythema multiforme vs. Stevens-Johnson syndrome and toxic epidermal necrolysis: an important diagnostic distinction]. Blood counts and bone marrow studies may reveal an underlying leukemia. A case of anti-BP230 antibody-positive dyshidrosiform bullous pemphigoid secondary to dipeptidyl peptidase-4 inhibitor in a 65-year-old Filipino female Systemic and potentially life-threatening complications include fluid and electrolyte imbalance, thermoregulatory disturbance, fever, tachycardia, high-output failure, hypoalbuminemia, and septicemia. EM usually occurs in young adults of 2040years of age [13], with women affected more frequently than men (1.5:1.0) [14]. 1983;8(6):76375. It should be used only in case of a documented positivity of cultural samples. Kano Y, et al. All Rights Reserved. Theoretically, any drug may cause exfoliative dermatitis. Contact Dermatitis. A multidisciplinary team is fundamental in the therapeutic management of patients affected by exfoliative DHR. Article California Privacy Statement, Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Among the anti-tubercular drugs exfoliative dermatitis is reported with rifampicin, isoniazid, ethambutol, pyrazinamide, streptomycin, PAS either singly or in combination of two drugs in some cases. Fitzpatricks dermatology in general medicine. erythroderma, exfoliative dermatitis, and fixed drug reactions) 4, 5 and . The erythrodermic form of mycosis fungoides and the Szary syndrome may also be difficult to distinguish from benign erythroderma. Ganciclovir and cidofovir should be used when polymerase-chain reactions (PCR) on peripheral blood or other biological sample identifies a viral reactivation (HHV6, HHV7, EBV and CMV). -. Hematologic: anemia, including aplastic and hemolytic. Erythema multiforme (EM), Stevens- Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Keywords: The authors concluded that they couldnt demonstrate corticosteroids efficacy in monotherapy, but the use of steroid alone is not linked to an increased risk of mortality due to infective complications [108, 109]. J Invest Dermatol. Mayes T, et al. These molecules may play a role in amplifying the immune response and in increasing the release of other toxic metabolites from inflammatory cells [48]. Google Scholar. and transmitted securely. Toxic epidermal necrolysis and StevensJohnson syndrome. Int J Dermatol. 2005;94(4):41923. Barbaud A. An extremely rare mucocutaneous adverse reaction following COVID-19 vaccination: Toxic epidermal necrolysis. Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Article The velocity of infusion should be regulated according to patients arterial pressure with the aim of 30mL/h urinary output (1mL/kg/h in case of a child). In addition to all these mechanisms, alarmins, endogenous molecules released after cell damage, were found to be transiently increased in SJS/TEN patients, perhaps amplifying the immune response, including -defensin, S100A and HMGB1 [47]. Gastrointestinal: pancreatitis, glossitis, dyspepsia. Anticoagulation therapy. It is important to protect the damaged skin with sterile fat dressing especially in the genital area. 2000;115(2):14953. Combination of infliximab and high-dose intravenous immunoglobulin for toxic epidermal necrolysis: successful treatment of an elderly patient. J Dermatol Sci. In an open trial on cyclosporine in 29 patients with TEN, the use of Cys A for at least 10days led to a rapid improvement without infective complications [112]. Considered variables in SCORTEN are shown in Table2. . In: Eisen AZ, Wolff K, editors. Br J Dermatol. Nayak S, Acharjya B. Stern RS. 2016;2:14. It is a clinical manifestation and usually associated with various underlying cutaneous disorders, drug induced reactions and malignancies. 1994;331(19):127285. 2019 Jan 6;59:463-486. doi: 10.1146/annurev-pharmtox-010818-021818. Int Arch Allergy Immunol. Drug induced exfoliative dermatitis (ED) are a group of rare and severe drug hypersensitivity reactions (DHR) involving skin and usually occurring from days to several weeks after drug exposure. Histopathological and epidemiological characteristics of patients with erythema exudativum multiforme major, StevensJohnson syndrome and toxic epidermal necrolysis. 2010;2(3):18994. 2008;53(1):28. An increased metabolism is typical of patients with extended disepithelizated areas. It is advised against the use of silver sulfadiazine because sulphonamide can be culprit agents. N Engl J Med. Unable to load your collection due to an error, Unable to load your delegates due to an error, Erythema multiforme (photo reproduced with permission of Gary White, MD): typical target lesions (, Mortality rate of patients with TEN has shown to be directly correlated to SCORTEN. Basal-cell carcinoma; Other names: Basal-cell skin cancer, basalioma: An ulcerated basal cell carcinoma near the ear of a 75-year-old male: Specialty 2013;69(2):1734. 2002;65(9):186170. CD94/NKG2C is a killer effector molecule in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. Several authors reported also an increased incidence for aminopenicillins, cephalosporins, and quinolones [61, 62]. Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist. 1997;19(2):12732. Exfoliative dermatitis has been reported in association with hepatitis, acquired immunodeficiency syndrome, congenital immunodeficiency syndrome (Omenn's syndrome) and graft-versus-host disease.2,1517, In reviews of erythroderma, a significant percentage of patients (about 25 percent) do not receive a specific etiologic diagnosis. J Am Acad Dermatol. 2011;20(5):103441. Khalil I, et al. Moreover, after granulysin depletion, they observed an increase in cell viability. Malignancies are a major cause of exfoliative dermatitis. PubMed 2008;14(12):134350. Ann Intern Med. Even though there is a strong need for randomized trials, anti-TNF- drugs, in particular a single dose of infliximab 5mg/kg ev or 50mg etanercept sc should be considered in the treatment of SJS and TEN, especially the most severe cases when IVIG and intravenous corticosteroids dont achieve a rapid improvement. A pseudolymphoma reaction with fever, arthralgias, lymphadenopathy, hepatosplenomegaly, anemia and erythroderma may develop as a result of hypersensitivity to dapsone or antiepileptic drugs. Oral hygiene with antiseptic and painkiller mouthwash (chlorhexidine+lidocaine+aluminum hydroxide) together with aerosol therapy with saline and bronchodilators can reduce upper airways symptoms. Paquet P, Pierard GE, Quatresooz P. Novel treatments for drug-induced toxic epidermal necrolysis (Lyells syndrome). During the acute reaction, diagnosis of ED is mainly based on clinical parameters. Mediterr J Hematol Infect Dis. Disasters. In more severe cases corneal protective lens can be used. PubMed Exfoliative dermatitis, also known as erythroderma, is an uncommon but serious skin disorder that family physicians must be able to recognize and treat appropriately. 2005;136(3):20516. Exfoliative dermatitis is also a risk factor for epidemic spread of methicillin-resistant Staphylococcus aureus.6,20. Generalized. Most common used drugs are: morphine, fentanyl, propofol and midazolam. Hospitalization is usually necessary for initial evaluation and treatment. The lymphocyte transformation test in the diagnosis of drug hypersensitivity. Br J Clin Pharmacol. Dent Clin North Am. Drug-induced hypersensitivity syndrome (DiHS) or drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug-induced reaction characterized by various symptoms: skin rash, fever, lymph node enlargement and internal organ involvement, which starts within 2 weeks to 3 months after drug initiation. Synthetic bilaminar membranes with silver nitrate have also a role in skin repairing and avoid protein loss through the damaged skin [100, 101]. Atypical target lesions manifest as raised, edematous, palpable lesions with only two zones of color change and/or an extensive exanthema with a poorly defined border darker in the center(Fig. Department of Allergy and Clinical Immunology, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy, Mona-Rita Yacoub,Maria Grazia Sabbadini&Giselda Colombo, Vita-Salute San Raffaele University, Milan, Italy, Mona-Rita Yacoub,Alvise Berti,Corrado Campochiaro,Enrico Tombetti,Giuseppe Alvise Ramirez,Maria Grazia Sabbadini&Giselda Colombo, Section of Allergy and Clinical Immunology, Dept. Abe R, et al. Recurrence occurs in around one-third of cases [15] and there is a genetic predisposition for certain Asian groups [16]. Clinical clues of a drug-induced etiology include: Abrupt onset, previous morbilliform eruption, multiple, varied cutaneous morphologic lesions present together Extensive erythema is followed in 2-6 days by exfoliative scaling Pruritus can be severe, leading to scratching and lichenification in more chronic processes If necessary, it can be repeated every 68h. NSAIDs should be avoided as they can induce ED as well. PubMed Clinical and Molecular Allergy Diclofenac sodium topical solution, like other NSAIDs, can cause serious systemic skin side effects such as exfoliative dermatitis, SJS, and TEN, which may result in hospitalizations . T and NK lymphocytes can produce FasL that eventually binds to target cells. Google Scholar. Linear IgA dermatosis most commonly presents in patients older than 30years. Defective regulatory T cells in patients with severe drug eruptions: timing of the dysfunction is associated with the pathological phenotype and outcome. Unlike EMM, SJS and TEN are mainly related to medication use. When it precedes cutaneous T-cell lymphoma lesions, exfoliative dermatitis becomes the presenting sign of the underlying malignancy. Medication use and the risk of StevensJohnson syndrome or toxic epidermal necrolysis. 1997;22(3):1467. Toxic epidermal necrolysis associated with severe cytomegalovirus infection in a patient on regular hemodialysis. In more severe cases continuous iv therapy can be necessary. Severe adverse cutaneous reactions to drugs. Main discriminating factors between EMM, SJS, SJS-TEN, TEN and SSSS is summarized in Table3 [84]. Umbilical cord mesenchymal stem cell transplantation in drug-induced StevensJohnson syndrome. Yamada H, Takamori K. Status of plasmapheresis for the treatment of toxic epidermal necrolysis in Japan. When less than 10% of the body surface area (BSA) is involved, it is defined SJS, when between 10 and 30% of BSA it is defined overlapping SJS/TEN, when more than 30% of BSA, TEN [2] (Additional file 1: Figure S1, Additional file 2: Figure S2). Hydration and hemodynamic balance. Google Scholar. Narita YM, et al. Br J Dermatol. A rare case of toxic epidermal necrolysis with unexpected Fever resulting from dengue virus. J Am Acad Dermatol. Australas J Dermatol. Ann Burns Fire. Staphylococcal Scalded Skin Syndrome: criteria for Differential Diagnosis from Lyells Syndrome. d. Cysts and tumors. Lymphocyte transformation test (LTT) performed as described by Pichler and Tilch [77] shows a lower sensitivity in severe DHR compared to less severe DHR [78] but, if available, should be performed within 1week after the onset of skin rash in SJS and TEN [79]. Fritsch PO. Fluid balance is a main focus. Drug induced exfoliative dermatitis (ED) are a group of rare and severe drug hypersensitivity reactions (DHR) involving skin and usually occurring from days to several weeks after drug exposure. Other patients may warrant PUVA (psoralen plus ultraviolet A) phototherapy, systemic steroids (if psoriasis has been ruled out), retinoids (for exfoliative dermatitis secondary to psoriasis and pityriasis rubra pilaris), or immunosuppressive agents such as methotrexate (Rheumatrex) and azathioprine (Imuran).2527, When used as adjunctive therapy, behavior modification designed to eliminate persistent scratching has been successful in reducing the rate of excoriation and increasing the rate of healing.28. The .gov means its official. Previous vol/issue. 2012;66(6):e22936. Lin YT, et al. 2010;31(1):1004. Scientific evidences suggest a role for HLAs and drug-induced SJS/TEN, although some racial differences have been found that can be due to variation of frequencies of these alleles and to the presence of other susceptibility genes [26]. Would you like email updates of new search results? 5% silver nitrate compresses have antiseptic properties. The authors declare that they have no competing interests. Drug rashes are the body's reaction to a certain medicine. Semin Dermatol. oboda J, Dudzik A, Chomyszyn-Gajewska M. Ramirez GA, Ripa M, Burastero S, Benanti G, Bagnasco D, Nannipieri S, Monardo R, Ponta G, Asperti C, Cilona MB, Castagna A, Dagna L, Yacoub MR. Microorganisms. 2. The enhanced activation of CD8 T cells seems also to be influenced by the impaired function of CD4+CD25+FoxP3+Treg cells found in the peripheral blood of TEN patients in the acute phase [46]. In spared areas it is necessary to avoid skin detachment. 2012;366(26):2492501. Not responsive to therapy. Bethesda, MD 20894, Web Policies Szary syndrome, the leukemic variant of mycosis fungoides, is also associated with exfoliative dermatitis. Ophthalmologic consultations must be repeated at fixed intervals to avoid the appearance of conjunctival irreversible complications such as chronic conjunctivitis with squamous metaplasia, trichiasis, symblepharon, punctate keratitis and sicca syndrome.