AAD
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  • Presentation

Severe Acute Cutaneous Adverse Drug Reactions

Description

The presentation discusses severe acute cutaneous adverse drug reactions (SCARs), dedicating the talk to Professor Jean Claude Rougeau, a recognized expert in the field. The session includes a quiz to assess audience knowledge on three main conditions: DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms), AJEB (Acute Generalized Exanthematous Pustulosis), and SJS/TEN (Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis). DRESS is highlighted as a particularly severe condition with significant mortality (10-20%), often linked to drug interactions and viral reactivation, characterized by varied cutaneous manifestations and systemic complications. Diagnosis and treatment strategies are outlined, emphasizing the importance of systemic steroid therapy tailored to individual patient needs. AJEB is noted as less severe with a quicker resolution upon drug discontinuation. SJS/TEN, presenting with severe pain and skin involvement, has a mortality rate of 30%. The discussion covers etiology, treatment modalities, and the psychological impact on survivors, and advocates for genetic screening to prevent such drug reactions. The session concludes with powerful testimonials from survivors of SJS and DRESS, sharing their emotional journeys and the consequences of inadequate treatment, emphasizing the urgency for better awareness and management of these conditions.

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Conclusions

  • DRESS is a severe drug reaction with a mortality rate of 10-20%, often induced by interactions between genetic predispositions, certain drugs, and viral reactivations.
  • Facial and earlobe edema, along with a rash involving more than 50% of the body surface area, are characteristic features of DRESS.
  • Diagnosis of DRESS can occur even without eosinophilia.
  • Systemic involvement in DRESS can include multi-organ dysfunction and is more critical than dermatological manifestations.
  • Prolonged systemic steroid treatment is essential in managing DRESS, especially in cases of systemic involvement or viral reactivation.
  • Cyclophosphamide and anti-IL-5 receptor antagonists have shown effectiveness in treating DRESS and can shorten hospitalization duration.
  • AGEP, another type of severe drug reaction, has a lower mortality rate of about 5% and a distinct morphology of skin reactions.
  • SJS/TEN is among the most severe cutaneous adverse reactions, with mortality rates as high as 30%, and requires prompt intensive care management.
  • Genetic screening, particularly for specific HLA alleles, is effective in predicting severe cutaneous adverse drug reactions and is recommended in high-risk populations.
  • The need for interdisciplinary follow-up care post-DRESS is vital for managing long-term complications and improving quality of life.
  • Br J Dermatol. 2021 Aug;185(2):470-471. doi: 10.1111/bjd.20076. Epub 2021 May 5.
  • Hannah Stirton 1 2, Neil H Shear 3, Roni P Dodiuk-Gad 3 4 5. Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS)/Drug-Induced Hypersensitivity Syndrome (DiHS) - Readdressing the DReSS. Biomedicines. 2022 Apr 26;10(5):999. doi: 10.3390/biomedicines10050999.
  • Management of Adult Patients With Drug Reaction With Eosinophilia and Systemic Symptoms: A Delphi-Based International Consensus. JAMA Dermatol. 2024 Jan 1;160(1):37-44. doi: 10.1001/jamadermatol.2023.4450.
  • Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: An Update. Am J Clin Dermatol. 2015 Dec;16(6):475-93. doi: 10.1007/s40257-015-0158-0.
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  • Severe Physical Complications among Survivors of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Drug Saf. 2018 Mar;41(3):277-284. doi: 10.1007/s40264-017-0608-0.
  • Current and Future Trends in Treatment of DReSS Syndrome. J Allergy Clin Immunol Pract. 2023 Oct;11(10):3161-3168.e2. doi: 10.1016/j.jaip.2023.07.001.
  • Evaluation of Cyclosporine for the Treatment of DRESS Syndrome. JAMA Dermatol. 2020 Jun;156(6):704-706. doi: 10.1001/jamadermatol.2020.0048.
  • Update on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Diagnosis and Acute Management. American Journal of Clinical Dermatology. 2024.
  • > Drug reaction with eosinophilia and systemic symptoms (DRESS): A systematic review. Awad A et al. J Allergy Clin Immunol Pract. March 2023.