Abstract
Morbilliform drug eruptions, also called exanthematous drug eruptions, are a form of delayed cutaneous hypersensitivity characterized by erythematous macules or papules that coalesce to form large plaques. The eruption usually occurs 5 days to 2 weeks after administration of the causative agent. The most common causes are antibiotics, anti-epileptics, allopurinol, non-steroidal anti-inflammatories (NSAIDS), anxiolytics, anti-hypertensives, and diuretics. They can also be associated with viral infections, illicit drug use, blood products, IV contrast media, and may have a genetic predisposition. With the cessation of the causative drug, morbilliform eruptions usually resolve within 1–2 weeks. The main histological features of morbilliform drug eruptions are a superficial and deep perivascular infiltrate and interstitial spongiotic and psoriasisiform dermatitis in conjunction with vacuolar interface changes. Although not completely understood, the immunological mechanisms for morbilliform drug eruptions involve a type IVb and IVc hypersensitivity reaction, as described by Gell and Coombs. Treatment for exanthematous drug reactions includes cessation of the causative agent and treatment of symptoms associated with the reaction, particularly pruritus.
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Suggested Reading
Ackerman A. Histologic diagnosis of inflammatory skin diseases. 1st ed. Baltimore: Williams & Wilkins; 1997.
Ahmed A, Pritchard S, Reichenberg J. A review of cutaneous drug eruptions. Clin Geriatr Med. 2013;29(2):527–45.
Bircher AJ. Exanthematous (morbilliform) drug eruption. 2014. http://www.uptodate.com/contents/exanthematous-morbilliform-drug-eruption?source=search_result&search=morbilliform+drug+eruptions&selectedTitle=1%7E11. Accessed 3 Apr 2014.
Bolognia J, Jorizzo J, Rapini R. Dermatology. 2nd ed. St. Louis: Mosby/Elsevier; 2008.
Brewster UC, Rastegar A. Acute interstitial nephritis. In: Gilbert SJ, Weiner DE, editors. National Kidney Foundation’s primer on kidney diseases. Philadelphia: Elsevier; 2014. p. 312–7.
Brönnimann M, Yawalkar N. Histopathology of drug-induced exanthems: is there a role in diagnosis of drug allergy? Curr Opin Allergy Clin Immunol. 2005;5:317–21.
Coombs PR, Gell PG. Classification of allergic reactions responsible for clinical hypersensitivity and disease. In: Gell RR, editor. Clinical aspects of immunology. Oxford: Oxford University Press; 1968. p. 575–96.
Côté B, Wechsler J, Bastuji-Garin S, Assier H, Revuz J, Roujeau JC. Clinicopathologic correlation in erythema multiforme and Stevens-Johnson syndrome. Arch Dermatol. 1995;131(11):1268–72.
Diaz L, Ciurea A. Cutaneous and systemic adverse reactions to antibiotics. Dermatol Ther. 2012;25(1):12–22.
Hari Y, Urwyler A, Hurni M, Yawalkar N, Dahinden C, Wendland T, et al. Distinct serum cytokine levels in drug–and measles–induced exanthema. Int Arch Allergy Immunol. 1999;120(3):225–9.
Hernández-Salazar A, Rosales SP, Rangel-Frausto S, Criollo E, Archer-Dubon C, Orozco-Topete R. Epidemiology of adverse cutaneous drug reactions. A prospective study in hospitalized patients. Arch Med Res. 2006;37(7):899–902.
Lerch M, Bircher AJ. Systemically induced allergic exanthem from mercury. Contact Dermatitis. 2004;50(6):349–53.
Marra DE, McKee PH, Nghiem P. Tissue eosinophils and the perils of using skin biopsy specimens to distinguish between drug hypersensitivity and cutaneous graft-versus-host disease. J Am Acad Dermatol. 2004;51(4):543–6.
Morrell DS, Pepping MA, Scott JP, Esterly NB, Drolet BA. Cutaneous manifestations of hemophagocytic lymphohistiocytosis. Arch Dermatol. 2002;138(9):1208–12.
Naim M, Weyers W, Metze D. Histopathologic features of exanthematous drug eruptions of the macular and papular type. Am J Dermatopathol. 2011;33(7):695–704.
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239–45.
Posadas SJ, Leyva L, Torres MJ, Rodriguez JL, Bravo I, Rosal M, et al. Subjects with allergic reactions to drugs show in vivo polarized patterns of cytokine expression depending on the chronology of the clinical reaction. J Allergy Clin Immunol. 2000;106(4):769–76.
Posadas S, Torres M, Mayorga C, Juarez C, Blanca M. Gene expression levels of cytokine profile and cytotoxic markers in non-immediate reactions to drugs. Blood Cells Mol Dis. 2002;29(2):179–89.
Profaizer T, Eckels D. HLA alleles and drug hypersensitivity reactions. Int J Immunogenet. 2012;39(2):99–105.
Roujeau J. Clinical heterogeneity of drug hypersensitivity. Toxicology. 2005;209(2):123–9.
Rzany B, Hering O, Mockenhaupt M, Schröder W, Goerttler E, Ring J, et al. Histopathological and epidemiological characteristics of patients with erythema exsudativum multiforme major, Stevens-Johnson syndrome and toxic epidermal necrolysis. Br J Dermatol. 1996;135(1):6–11.
Schnyder B, Frutig K, Mauri-Hellweg D, Limat A, Yawalkar N, Pichler W, et al. T-cell-mediated cytotoxicity against keratinocytes in sulfamethoxazole-induced skin reaction. Clin Exp Allergy. 1998;28:1412–7.
Shin H, Chang M. Drug eruptions in children. Curr Probl Pediatr. 2001;31(7):207–34.
Stacul F. Late adverse reactions to intravascular iodinated contrast media. In: Thomsen HS, editor. Contrast media. 1st ed. Berlin/Heidelberg: Springer; 2006. p. 27–31.
Tapia B, Padial A, Sánchez-Sabaté E, Alvarez-Ferreira J, Morel E, Blanca M, et al. Involvement of CCL27-CCR10 interactions in drug-induced cutaneous reactions. J Allergy Clin Immunol. 2004;114(2):335–40.
Torres M, Mayorga C, Blanca M. Nonimmediate allergic reactions induced by drugs: pathogenesis and diagnostic tests. J Investig Allergol Clin Immunol. 2009;19(2):80–90.
Valeyrie-Allanore L, Sassolas B, Roujeau J. Drug-induced skin, nail and hair disorders. Drug Saf. 2007;30(11):1011–30.
Yawalkar N. Drug-induced exanthems. Toxicology. 2005;209(2):131–4.
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Ukoha, U.T., Pandya, A.G., Dominguez, A.R. (2015). Morbilliform Drug Eruptions. In: Hall, J., Hall, B. (eds) Cutaneous Drug Eruptions. Springer, London. https://doi.org/10.1007/978-1-4471-6729-7_5
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DOI: https://doi.org/10.1007/978-1-4471-6729-7_5
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