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Medical review by Dr Pierre Schneider, Dermatologist, Saint-Louis Hospital, France
By
Dr. Pierre Schneider
Related topics
Immunological toxidermia can be mediated by two different mechanisms1 :
The most frequent forms1,2:
Fig: Fixed erythema pigmentosum
Rare. Recognized by several criteria:
Fig 1,2,3: DRESS Syndrome
Among the drugs implicated in DRESS, the most frequently suspected are:
Fig 1: Stevens-Johson Syndrome; Fig 2: Lyell-TEN Syndrome
The mortality risk for this toxidermia is high: 4.8% for SJS, 19.4% for SJS-TEN overlap and 14.8% for TEN6. Re-epidermalization occurs within 10 to 30 days, with frequent sequelae: pigmentation disorders and mucosal scars, especially in the eyes (synechiae).
Epidemiological case-control studies conducted in Europe by EuroSCAR2 have identified the drugs responsible for Stevens-Johnson syndrome and toxic epidermal necrolysis, namely antibacterial sulfonamides, allopurinol, carbamazepine, phenobarbital, phenytoin, non-steroidal anti-inflammatory drugs of the oxicam family and, to a lesser extent, nevirapine, lamotrigine, sertraline, pantoprazole and tramadol6.
Fig 1,2: Acute urticaria
Superficial and/or deep urticaria may, in rare cases, be associated with an episode of anaphylaxis.
Rash occurring within hours of exposure to the sun. Localized on the exposed areas: photodistribution.
It depends on two distinct mechanisms:
2. Phototoxicity
It occurs in the hours following sun exposure.
Contact dermatitis: Clinic, diagnosis and treatment
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