Oral manifestations of erythema multiforme. They usually have fever, are dyspneic and cannot physiologically feed. 1990;126(1):3742. Patients with carcinoma of the colon, lung, prostate and thyroid have presented with erythroderma. StevensJohnson syndrome and toxic epidermal necrolysis: a review of the literature. Ko TM, et al. Inhibition of toxic epidermal necrolysis by blockade of CD95 with human intravenous immunoglobulin. In postmarketing reports, cases of drug-induced hepatotoxicity have been reported in the first month, and in some cases, the first 2 months of therapy, but can occur at any time during treatment with diclofenac. Erythema multiforme and toxic epidermal necrolysis. Su SC, Hung SI, Fan WL, Dao RL, Chung WH. Erythema multiforme (photo reproduced with, 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, Management of patients with a suspected drug induced exfoliative dermatitis, MeSH Bookshelf For carbamazpine, several studies have found a common link between specific HLAs and different kinds of cutaneous adverse reactions, as for HLA-A*3101 in Japanese [30] and Europeans [31]. Effects of treatments on the mortality of StevensJohnson syndrome and toxic epidermal necrolysis: a retrospective study on patients included in the prospective EuroSCAR Study. Tohyama M, et al. Erythema multiforme to amoxicillin with concurrent infection by Epstein-Barr virus. 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 . 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]. Skin testing in delayed reactions to drugs. (adult rickets), anticonvulsant-induced rickets and osteomalacia, osteoporosis, renal osteodystrophy . Therefore, the clinician should always consider drugs as a possible cause. Drug-Induced Kidney Injury & Exfoliative Dermatitis Symptom Checker: Possible causes include Gold Salt. Rheumatology (Oxford). Correspondence to CAS 2013;133(5):1197204. 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]. Overall, incidence of SJS/TEN ranges from 2 to 7 cases per million person per year [9, 1820], with SJS the commonest [21]. official website and that any information you provide is encrypted Erythema multiforme (EM), StevensJohnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. J Invest Dermatol. Br J Dermatol. Although the etiology is. A case of anti-BP230 antibody-positive dyshidrosiform bullous pemphigoid secondary to dipeptidyl peptidase-4 inhibitor in a 65-year-old Filipino female Erythema multiforme StevensJohnson syndrome and toxic epidermal necrolysis. J Invest Dermatol. 2014;71(5):9417. 3. Drug-induced LPP. Skin and appendages: acne, bruising, erythema multiforme, exfoliative dermatitis, pruritus ani, rash, skin ulceration, Stevens . Talk to our Chatbot to narrow down your search. Drug Induced Interstitial Nephritis, Hepatitis and Exfoliative Dermatitis Kostal M, et al. Roujeau JC, et al. Disasters. 1991;97(4):697700. Toxic epidermal necrolysis and StevensJohnson syndrome. Huang SH, et al. Bullous FDE. 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. Wolkenstein P, et al. 2015;56(4):298302. Guidelines for the management of drug-induced liver injury[J]. 2023 Jan 30;11(2):346. doi: 10.3390/microorganisms11020346. Harr T, French LE. Careers. Acute interstitial nephritis associated with hepatitis, exfoliative dermatitis, fever and eosinophilia is uncommon. Options include use of PUVA light therapy, total-body electron beam irradiation, topical nitrogen mustard, systemic chemotherapy and extracorporeal photopheresis. Hypothermia can result in ventricular flutter, decreased heart rate and hypotension. When it precedes cutaneous T-cell lymphoma lesions, exfoliative dermatitis becomes the presenting sign of the underlying malignancy. Manganaro AM. Unfortunately, the clinical picture does not contribute to an understanding of the underlying cause. Clinical classification of cases of toxic epidermal necrolysis, StevensJohnson syndrome, and erythema multiforme. Hospitalization is usually necessary for initial evaluation and treatment. Int J 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. No uniformity of opinion exists concerning the best treatment for cutaneous T-cell lymphoma. Von Hebra first described erythroderma (exfoliative dermatitis) in 1868. A switch to oral therapy can be performed once the mucosal conditions improve. 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. Drug-Induced Kidney Injury & Exfoliative Dermatitis: Causes & Reasons 2002;65(9):186170. Previous vol/issue. It has a wide spectrum of severity, and it is divided in minor and major (EMM). d. Cysts and tumors. 2013;52(1):3444. The management of toxic epidermal necrolysis. Toxic epidermal necrolysis: Part I Introduction, history, classification, clinical features, systemic manifestations, etiology, and immunopathogenesis. Analysis of StevensJohnson syndrome and toxic epidermal necrolysis using the Japanese Adverse Drug Event Report database. 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;71(1):1956. Patmanidis K, et al. 2007;48(5):10158. Google Scholar. Corticosteroids could also reduce the amount of keratinocytes apoptosis and the activation of caspases [105]. Students also viewed Nostra aetate - Summary Theology: the basics Principles of Risk Management and Insurance Chapters 1-4 -, Schwartz RA, McDonough PH, Lee BW. National Library of Medicine 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. 2009;29(3):51735. Trialon | 40 mg/ml | Injection | ../.. Combination of infliximab and high-dose intravenous immunoglobulin for toxic epidermal necrolysis: successful treatment of an elderly patient. 2010;5:39. Epub 2018 Aug 22. A serious cutaneous adverse drug reaction namely exfoliative dermatitis (erythroderma) is associated with isoniazid use . In more severe cases antiviral therapies should be given together with intravenous immunoglobulins [93]. Ardern-Jones MR, Friedmann PS. 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. First of all, Sassolas and coauthors proposed an algorithm of drug causality (ALDEN) in order to improve the individual assessment of drug causality in TEN and SJS [71]. Case Rep Dermatol Med. 2016 Nov 15;17(11):1890. doi: 10.3390/ijms17111890. Skin manifestations of drug allergy. 2006;19(4):18891. After 24 hours, split formation was evident in hematoxylin and eosin-stained sections of HOSCs treated . Genome-scale investigation of drug-induced termination codon-readthrough in a model system of epidermolysis bullosa . Bastuji-Garin S, et al. PubMed Central Mayes T, et al. Initial symptoms could be aspecific, as fever, stinging eyes and discomfort upon swallowing, occurring few days before the onset of mucocutaneous involvement. Plasmapheresis. Many people have had success using a dilute vinegar bath rather than a bleach bath. The diagnosis of GVDH requires histological confirmation [87]. 2008;59(5):8989. Moreover, transpiration and thermoregulation are greatly impaired with an elevated loss of fluids, proteins and electrolytes through the damaged skin and mucosae. Wu PA, Cowen EW. Medication use and the risk of StevensJohnson syndrome or toxic epidermal necrolysis. Clinical features; Delayed type hypersensitivity; Drug hypersensitivity; Erythema multiforme; Exfoliative dermatitis; Lyells syndrome; Pathogenesis; StevensJohnson syndrome; Therapy; Toxic epidermal necrolysis. Pathogenicity and Virulence of Staphylococcus Aureus | PDF 2012;66(3):1906. Other clinical findings include lymphadenopathy, hepatomegaly, splenomegaly, edema of the foot or ankle4,6 and gynecomastia.19, The scaling that occurs in exfoliative dermatitis can have severe metabolic consequences, depending on the intensity and the duration of the scaling. Etanercept: monoclonal antibody against the TNF- receptor. Nassif A, et al. [3] The causes and their frequencies are as follows: Idiopathic - 30% Drug allergy - 28% Seborrheic dermatitis - 2% Contact dermatitis - 3% Atopic dermatitis - 10% Lymphoma and leukemia - 14% Psoriasis - 8% Treatment [ edit] UpToDate Captopril and Hydrochlorothiazide Tablet Prescribing Information It should be used only in case of a documented positivity of cultural samples. 8600 Rockville Pike Possible involvement of CD14+CD16+monocyte lineage cells in the epidermal damage of StevensJohnson syndrome and toxic epidermal necrolysis. Drugs causing erythroderma | DermNet 2011;128(6):126676. 19 Key critical interactions are discussed below for each mpox antiviral. Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist. 2001;108(5):83946. Dent Clin North Am. 2012;43:10115. Its also characterized by a cell-poor infiltrate, where macrophages and dendrocytes with a strong TNF- immunoreactivity predominate [6, 50]. A useful sign for differential diagnosis is the absence of mucosal involvement, except for conjunctiva. 2010;2(3):18994. Fitzpatricks dermatology in general medicine. Among drug related cases, the main triggering factors are sulfonamides, nonsteroidal anti-inflammatories (NSAIDs), penicillins, and anticonvulsants (Table1) [59]. All the linen must be sterile. EM is a self-limited skin condition mainly associated with infections and drugs [53, 54]. doi: 10.1016/j.jaad.2013.05.003. Ther Apher Dial. Am J Clin Dermatol. Pfizer Receives Positive FDA Advisory Committee Votes Supporting PubMed Central Kaffenberger BH, Rosenbach M. Toxic epidermal necrolysis and early transfer to a regional burn unit: is it time to reevaluate what we teach? Severe Cutaneous Adverse Reactions: The Pharmacogenomics from Research to Clinical Implementation. In serious cases invasive ventilation can be necessary for ARDS. Anti-tubercular therapy (ATT) induced exfoliative dermatitis-A case Ibuprofen Zentiva can be prescribed with OTC Recipe - self-medication. Once established the percentage of the involved skin, lactate Ringer infusion of 12mL/Kg/% of involved skin must be started during the first 24h [91]. Oliveira L, Zucoloto S. Erythema multiforme minor: a revision. Exfoliative dermatitis, including Stevens-Johnson syndrome, drug rash with eosinophilia and systemic symptoms, and toxic epidermal necrolysis, has occurred with anti-PD-1/PD-L1 treatments. Granulysin is a key mediator for disseminated keratinocyte death in StevensJohnson syndrome and toxic epidermal necrolysis. A pseudolymphoma reaction with fever, arthralgias, lymphadenopathy, hepatosplenomegaly, anemia and erythroderma may develop as a result of hypersensitivity to dapsone or antiepileptic drugs. In case of a respiratory failure, oxygen should be administrated and a NIMV may be required. It might be. Patch testing in severe cutaneous adverse drug reactions, including StevensJohnson syndrome and toxic epidermal necrolysis. It is also extremely important to obtain within the first 24h cultural samples from skin together with blood, urine, nasal, pharyngeal and bronchus cultures. Hum Mol Genet. The exact role of FasL in the pathogenesis of toxic epidermal necrolysis is still questionable especially because a correlation between serum FasL levels and disease severity has not been established and because its levels have been found to be increased also in drug-induced hypersensitivity syndrome and maculopapular eruption [36]. 2012;13(1):4954. The prognosis of cases associated with malignancy typically depends on the outcome of the underlying malignancy. 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]. Severe adverse cutaneous reactions to drugs. Check the full list of possible causes and conditions now! FDA Drug information Palynziq Read time: 10 mins Marketing start date: 04 Mar 2023 . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Yacoub, MR., Berti, A., Campochiaro, C. et al. Br J Dermatol. 2012;42(2):24854. Clinical, etiologic, and histopathologic features of StevensJohnson syndrome during an 8-year period at Mayo Clinic. EMM is a clinically severe, potentially life-threatening, extensive sloughing of epidermis, generally involving mucosal tissue. 2012;97:14966. 2014;81(1):1521. Open trial of ciclosporin treatment for StevensJohnson syndrome and toxic epidermal necrolysis. 2008;23(5):54750. Gueudry J, et al. Sequelae of exfoliative dermatitis are not widely reported. Grieb G, et al. Descamps V, Ranger-Rogez S. DRESS syndrome. As written before, Sassolas B. et al. 2010;85(2):1318. PubMed Staphylococcal Scalded Skin Syndrome: criteria for Differential Diagnosis from Lyells Syndrome. Article 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. In order to rule out autoimmune blistering diseases, direct immune fluorescence staining should be additionally performed to exclude the presence of immunoglobulin and/or complement deposition in the epidermis and/or the epidermal-dermal zone, absent in ED. Medication-Induced Erythroderma | SpringerLink 543557. Terms and Conditions, Kirchhof MG et al. Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. New York: McGraw-Hill; 2003. p. 585600. Curr Probl Dermatol. Allergy. Although the etiology is often unknown, exfoliative dermatitis may be the result of a drug reaction or an underlying malignancy. Drug induced exfoliative dermatitis: state of the art. - Abstract Chang CC, et al. Allergol Int. Schopf E, et al. HLA-B* 5801 allele as a genetic marker for severe cutaneous adverse reactions caused by allopurinol. Patient must be placed in an antidecubitus fluidized bed and room temperature must be kept at 3032C in order to slow catabolism and reduce the loss of calories through the skin [89]. J Clin Apher. Umbilical cord mesenchymal stem cell transplantation in drug-induced StevensJohnson syndrome. CAS Would you like email updates of new search results? Overall, T cells are the central player of these immune-mediated drug reactions. 2012;366(26):2492501. b. Atopic dermatitis. 2013;69(2):173174. Pyrazinamide-Induced Exfoliative Dermatitis in a Patient on - Hindawi Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Recurrence occurs in around one-third of cases [15] and there is a genetic predisposition for certain Asian groups [16]. A rare case of toxic epidermal necrolysis with unexpected Fever resulting from dengue virus. Analysis for circulating Szary cells may be helpful, but only if the cells are identified in unequivocally large numbers. Szary syndrome, the leukemic variant of mycosis fungoides, is also associated with exfoliative dermatitis. Erythema multiforme (photo reproduced with permission of Gary White, MD): typical target lesions (white arrows) together with atypical two-zoned lesions (black arrows). 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]. This is due to a reaction to certain medicines, a pre-existing skin condition, and sometimes cancer. Abstract Acute interstitial nephritis associated with hepatitis, exfoliative dermatitis, fever and eosinophilia is uncommon. Acute processes usually favor large scales, whereas chronic processes produce smaller ones. Article A marker for StevensJohnson syndrome: ethnicity matters. Eur J Clin Microbiol Infect Dis. . A multidisciplinary team is fundamental in the therapeutic management of patients affected by exfoliative DHR. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Copyright 2023 American Academy of Family Physicians. TNF- has a dual role: interacts with TNF-R1 activating Fas pathway and activates NF-B leading to cell survival. FOIA Iv bolus of steroid (dexamethasone 100300mg/day or methylprednisolone 2501000mg/day) for 3 consecutive days with a gradual taper steroid therapy is sometimes advised. TEN is also known as Lyell syndrome, since it was first described by Alan Lyell in 1956 [2, 60]. Rzany B, et al. A review of DRESS-associated myocarditis. Schwartz RA, McDonough PH, Lee BW. Arch Dermatol. CD94/NKG2C is a killer effector molecule in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. Paquet P, et al. Toxic epidermal necrolysis and StevensJohnson syndrome. Locharernkul C, et al. Role of nanocrystalline silver dressings in the management of toxic epidermal necrolysis (TEN) and TEN/StevensJohnson syndrome overlap. Smith SD, et al. 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). A severity-of-Illness score for toxic epidermal necrolysis (SCORTEN) has been proposed and validated to predict the risk of death at admission [81]. Exfoliative dermatitis (ED) is defined as diffuse erythema and scaling of the skin involving more than 90% of the total body skin surface area. J Am Acad Dermatol. Recently, a meta-analysis based on 6 retrospective studies evaluating the role of corticosteroids alone or together with IVIG has been published [107]. Drug induced interstitial nephritis, hepatitis and exfoliative dermatitis 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 . 2004;59(8):80920. 2008;34(1):636. 2011;20(5):103441. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. The drug level peaks after 1- 4 h in plasma after ingestion with 95% protein binding. Case Rep Dermatol. J Am Acad Dermatol. Exfoliative dermatitis is characterized by generalized erythema with scaling or desquamation affecting at least 90% of the body surface area. Defective regulatory T cells in patients with severe drug eruptions: timing of the dysfunction is associated with the pathological phenotype and outcome. Some anti-seizure medicines have also been known to cause exfoliative dermatitis. Article Chan HL, et al. 2. The site is secure. Generalized Exfoliative Dermatitis | Johns Hopkins Medicine PubMed Drug induced exfoliative dermatitis - yxw_88 - | All authors read and approved the final manuscript. Ann Pharmacother. It is a clinical manifestation and usually associated with various underlying cutaneous disorders, drug induced reactions and malignancies. An official website of the United States government. All Rights Reserved. J Am Acad Dermatol. Prevalence is low, with mortality of roughly 512.5% for SJS and 50% for TEN [1, 2]. 2008;53(1):28. All non-indispensable drugs have to be stopped because they could alter the metabolism of the culprit agent. Exfoliative Dermatitis as a Para-neoplastic Syndrome of Prostate Several authors reported also an increased incidence for aminopenicillins, cephalosporins, and quinolones [61, 62]. Theoretically, any drug can trigger a reaction, but the medications most associated with this disorder are: Allopurinol; Antiepileptic medications; Barbiturates 2012;166(2):32230. Clinical Considerations for Treatment and Prophylaxis of Mpox Infection Pharmacogenetics studies have found an association between susceptibility to recurrent EM in response to several stimuli and human leukocyte antigen (HLA) haplotypes of class II, in particular HLA DQB1*0301 [23]. Dermatologist and/or allergist should confirm the diagnosis, individuate the culprit agent, give indications about skin management and necessity to obtain theconsultationofthe ENT specialist, the gynecologist/urologist, the ophthalmologist and/or the pulmonologist in the case of mucosal involvement. Drug induced exfoliative dermatitis: state of the art The EuroSCAR-study. [Erythema multiforme vs. Stevens-Johnson syndrome and toxic epidermal necrolysis: an important diagnostic distinction]. 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. Jarrett P, et al. Manage cookies/Do not sell my data we use in the preference centre. View ABRIGO_Worksheet #8 Drug Study_Endocrine System.pdf from NCM 06 at Southern Luzon State University (multiple campuses). 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. Med Sci Monit. Orphanet J Rare Dis. Dupixent DUPILUMAB 200 mg/1.14mL sanofi-aventis U.S. LLC In conclusion, therapy wth IVIG should be started within the first 5days and an high-dosage regimen should be preferred (2.54g/kg for adults and 0.251.5g/kg in children divided in 35days). If it is exfoliative dermatitis that's drug induced, it's easy to treat . Fritsch PO. Albeit the lack of epidemiologic data regarding EM, its reported prevalence is less than 1% [710]. J Dermatol Sci. Erythroderma in adults - UpToDate Drug-induced Exfoliative Dermatitis & Eosinophils Increased Symptom Checker: Possible causes include Exfoliative Dermatitis. More recently, carcinomas of the fallopian tube,12 larynx13 and esophagus14 have been reported as causes of exfoliative dermatitis. 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]. Dermatologic disorders occasionally present as exfoliative dermatitis. Toxic epidermal necrolysis: effector cells are drug-specific cytotoxic T cells. EDs are serious and potentially fatal conditions. Recurrent erythema multiforme: clinical characteristics, etiologic associations, and treatment in a series of 48 patients at Mayo Clinic, 2000 to 2007. 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. In EMM lesions typically begin on the extremities and sometimes spread to the trunk. Infliximab: chimeric IgG monoclonal anti-TNF- antibody. 1994;331(19):127285. Exfoliative dermatitis is a disease process in which most, and sometimes all, of the skin is involved in erythematous inflammation resulting in massive scaling.1 A variety of diseases and other exogenous factors may cause exfoliative dermatitis. Furosemide or ethacrynic acid may be required to maintain an adequate urinary output [90]. Ayangco L, Rogers RS 3rd. Drug eruptions that initially present as morbilliform, lichenoid or urticarial rashes may progress to generalized exfoliative dermatitis. Curr Opin Allergy Clin Immunol. 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]. It often precedes or is associated with exfoliation (skin peeling off in scales or layers), when it may also be known as exfoliative dermatitis (ED). The erythrodermic form of mycosis fungoides and the Szary syndrome may also be difficult to distinguish from benign erythroderma. Cookies policy. This site needs JavaScript to work properly. Diagnosis in a routine setting is based on patch test (PT) while skin test (prick and intradermal tests) with a delayed reading are contraindicated in these patients [72]. Drug rashes are the body's reaction to a certain medicine. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Volume 8, Issue 1 Pages 1-90 (August 1994). Tohyama M, Hashimoto K. Immunological mechanisms of epidermal damage in toxic epidermal necrolysis. Br J Clin Pharmacol. 585600. Kavitha Saravu. Exfoliative Dermatitis: Definition, Causes, Treatments and More As described in Table3, major differential diagnosis of EM and SJS/TEN are (1) staphylococcal scalded skin syndrome (SSSS), (2) autoimmune blistering diseases and disseminated fixed bullous drug eruption, (3) others severe delayed DHR [6, 70, 82] (4) Graft versus host disease. Still, treatment indication, choice and dosage remain unclear, and efficacy yet unproven. HLA-B1502, HLA-B5701, HLA-B5801 and carbamazepine, abacavir, and allopurinol, respectively). Incidence of hypersensitivity skin reactions. Medical search. Frequent Retrospective review of StevensJohnson syndrome/toxic epidermal necrolysis treatment comparing intravenous immunoglobulin with cyclosporine. Br J Dermatol. Google Scholar.