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The present case series examined five instances of psoriasiform drug eruption diagnosed between 2014 and 2022 at the study site and 23 cases of drug eruption manifesting psoriasiform lesions which had been reported between 1986 and 2022. The causative drug, distribution of the skin eruptions, clinical latency to eruption, treatment course, and histopathological findings were investigated. The most common causative agents were calcium channel blockers (CCB) (64.5%). Of the 28 cases of psoriasiform drug eruption for which details of the eruption sites were reported, 46.4% occurred on the face, which was slightly higher than the usual distribution of psoriasis. CCB were responsible for 80.0% of the cases of facial skin rash. The mean time from the administration of the suspected drug to eruption onset was 25.0 months (range: 0.5–120 months; median: 13.0 months). In all the cases, the skin rash improved after the causative drug was discontinued. CCB were the most common causative agent, and the eruptions more commonly occurred on the face than in normal psoriasis, suggesting that it is especially important to confirm whether there is a history of CCB administration in psoriasis patients with extensive, facial skin eruptions. [ABSTRACT FROM AUTHOR]

Background. Fixed drug eruption and Rowell syndrome stand as intriguing entities with overlapping clinical and pathological features. Case Presentation. A 32-year-old female patient presented with a tender and pruritic rash on the left upper chest for 3 days. Clinical examination revealed a flaring rash on the chest, under her left eye, tongue, and lips. The patient had a significant past medical history of systemic lupus erythematous with positive (ANA, Sm, dsDNA, ribosomalP, RNP) antibodies, hypocomplementemia, inflammatory arthritis, discoid lupus, leukopenia, thrombocytopenia, and immune thrombocytopenic purpura, and avascular necrosis affecting both hips and her right knee. At the time of presentation, the patient was on azathioprine 150 mg daily and hydroxychloroquine 200 mg twice daily. Skin biopsy of the left upper chest revealed interface dermatitis with necrotic keratinocytes at the dermal-epidermal junction. Superficial and, in some areas, deep perivascular and peri adnexal lymphocytic infiltrates were observed, accompanied by eosinophils. CD123 staining highlighted 16% of the inflammatory cells. Direct Immunofluorescence for IgG, IgA, IgM, C3, and fibrinogen revealed positive linear basement membrane staining for IgG and fibrinogen, with no significant staining for the remaining immunoreactants. Considering the patient's history of medicine usage, and negative SS-A and SS-B antibody, a fixed drug eruption was favored. Discussion. This article discusses the clinical presentations, pathophysiological mechanisms, and diagnostic criteria for fixed drug eruption and Rowell syndrome. Conclusion. Awareness of the distinct clinical and histopathologic features of fixed drug eruption and Rowell syndrome, particularly when sharing cutaneous manifestations, underscores the importance of a comprehensive diagnostic approach and laboratory testing. [ABSTRACT FROM AUTHOR]

Pityriasis rosea is an acute, self‐limited exanthem that typically occurs in adolescence and young adulthood, classically featuring ovoid erythematous and scaly lesions on the trunk and proximal extremities. While its cause is not definitively known, the classic form of pityriasis rosea may result from the reactivation of latent human herpesvirus (HHV) infections (HHV‐6 and HHV‐7). Interestingly, drug eruptions that clinically and/or histopathologically resemble pityriasis rosea have also been reported. These pityriasis rosea‐like drug eruptions tend to occur at an older age and have a shorter duration than the classic type. As there are different management paradigms, the distinction between classic pityriasis rosea and the mimicking drug eruption is important to recognize. Herein, we report a case of a pityriasis rosea‐like drug eruption that occurred in association with imatinib mesylate treatment for chronic myeloid leukemia. We also review the clinicopathologic features of reported cases of pityriasis rosea‐like drug eruption, including those due to imatinib. While the clinical morphology of the cutaneous drug‐related eruption mimics the lesions seen in classic pityriasis rosea, the presence of unique histopathologic findings, including necrotic keratinocytes, interface dermatitis, and eosinophils, may aid in distinction. [ABSTRACT FROM AUTHOR]

Enfortumab vedotin (EV), a nectin‐4‐binding agent that affects microtubules, has become standard therapy for advanced urothelial carcinoma. The agent, now given in combination with pembrolizumab, frequently induces cutaneous reactions. Here, we report a severe EV‐induced cutaneous eruption. A 58‐year‐old woman with metastatic urothelial carcinoma developed a rash after receiving simultaneous first doses of EV and pembrolizumab. The eruption began on the flank and spread to involve her trunk and extremities with prominent involvement of folds, including the axillae and medial thighs. Skin biopsy revealed extensive vacuolar alteration of the basal epidermis and numerous epidermal keratinocytic mitotic figures, often suprabasilar, including ring and "starburst" forms. The findings supported a diagnosis of EV‐induced eruption. With EV cessation and systemic corticosteroids, the rash resolved over a few weeks. Pembrolizumab was restarted as monotherapy, and the patient's cancer showed a significant radiographic treatment response at 3 months. An emerging literature of small series and case reports, largely from oncologic literature, presents the histopathology of EV‐induced cutaneous eruption as a vacuolar interface dermatitis with the inconsistently reported feature of arrested mitotic figures. This case study demonstrates distinctive clinical and histopathologic features of EV‐induced eruption, which may inform dermatologic and oncologic management. [ABSTRACT FROM AUTHOR]

Recently, there has been discussion to reclassify pediatric Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) as drug-induced epidermal necrolysis (DEN), separating it from infectious etiologies and redefining pediatric mucocutaneous eruptions as either reactive infectious mucocutaneous eruption (RIME) or DEN. In this report, we describe a previously healthy 4-year-old girl with rapidly progressive mucocutaneous blistering involving four mucosal membranes and 37.5% of total body surface area (BSA) following a prodromal rhinovirus and enterovirus infection. The symptoms occurred in the absence of an inciting medication and improved with only supportive care. This case illustrates a rare occurrence of RIME with TEN-like BSA involvement, prompting a review of the literature exploring the relationship between BSA involvement in RIME and its influence on patient outcomes. Findings support the proposed reclassification of SJS/TEN as DEN and postinfectious mucocutaneous eruptions as RIME.

Abstract Background Acute generalized exanthematous pustulosis (AGEP) is a rare and severe cutaneous drug eruption. Hydroxychloroquine (HCQ) is one of the known culprit drugs with less than 60 cases reported in the literature, and may have a more severe clinical presentation compared to AGEP induced by other drugs. There are no standardized management strategies for HCQ‐induced AGEP outside of drug discontinuation. Objectives Characterize the clinical presentation of HCQ‐induced AGEP and management strategies. Methods Retrospective chart review of nine patients clinically diagnosed with HCQ‐induced AGEP using the EuroSCAR score from 2017 to 2022 at four academic medical centres in the United States. Results All patients in our series were female and the median age was 52. Four patients initially presented with fever, and eight patients had neutrophilia. Median time to rash was 15 days. Biopsies obtained in six patients showed typical characteristics of AGEP. In most patients, rash morphology consisted of generalized pinpoint pustules atop atypical targetoid lesions and annular plaques. Five patients were hospitalized for AGEP. All patients were treated with methylprednisolone and/or prednisone, and the average days treated with systemic corticosteroids was 35. Conclusions Our case series is the largest to date describing HCQ‐induced AGEP. Clinicians should be wary that HCQ‐induced AGEP may present with a longer latency period after drug initiation and with atypical targetoid and annular lesions. Early initiation of systemic corticosteroids should be considered due to the severity of this drug reaction with addition of cyclosporine in refractory cases.

This article is a case report of a 53-year-old woman who developed acute generalised exanthematous pustulosis (AGEP) after receiving betamethasone sodium phosphate treatment for COVID-19. The woman had a history of contact dermatitis and AGEP caused by other steroids in the past. Patch tests confirmed her allergy to certain groups of corticosteroids. Her skin rash improved with topical treatment. The article highlights the rare occurrence of AGEP induced by systemic steroids and emphasizes the importance of conducting various tests for accurate diagnosis. [Extracted from the article]

Symmetric drug-related intertriginous and flexural exanthema (SDRIFE) is a cutaneous drug reaction that presents with symmetrical erythema in the flexures. The reaction typically appears hours-to-days after drug exposure but has been reported to occur months after drug initiation. Diagnostic criteria include cutaneous reaction after exposure to a systemic drug, erythema of the gluteal region and/or V-shaped erythema of the inguinal areas, involvement of an additional intertriginous site, symmetry, and absence of systemic involvement. The rash typically presents as macular erythema. However, variations in morphology have been reported including papules, pustules, vesicles, and bullae. The histopathology of SDRIFE is non-specific and the diagnosis is made clinically. Cessation of the causative drug leads to gradual rash resolution. Beta-lactam antibiotics are the most implicated medications but case reports describe SDRIFE following monoclonal antibodies, chemotherapeutic agents, and various other medications. We present a patient with SDRIFE secondary to lenalidomide, an immunomodulatory agent. This case highlights the importance of considering SDRIFE in the differential diagnosis of patients presenting with intertriginous erythema.

Secukinumab and ixekizumab are IL17A inhibitors most commonly used to treat psoriasis. Common side effects include upper respiratory tract infections, injection site reactions, and mucocutaneous candidiasis. Recently, these medications have been reported to trigger lichen planus and lichenoid reactions have also been reported as an emerging side effect of biologics, especially tumor necrosis factor inhibitors. Herein, we report a patient with lichen planus that appeared after initiation of secukinumab for the treatment of psoriasis.

Purpose of review: This review describes risk factors for severe skin reactions to antiseizure medications (ASMs), the usage of updated tests to predict those with increased risk of a severe cutaneous reaction, and guides how to choose specific ASMs and dosing to lower the risk for these reactions. Information is given regarding specific mild versus severe reactions, initial diagnostic evaluation, and treatment. A table listing the risk of mild and severe cutaneous reaction risks as well as the management of potential seizures that may occur while stopping the culprit ASM are provided. Recent findings: Five new ASMs have joined the total of 26 FDA-approved ASMs since 2018. Cenobamate had three patients develop a drug reaction with eosinophilia and systemic symptoms. A lower starting dosing and slower titration have resulted in no further published cases. Based on limited data, rash risk is low for fenfluramine, ganaxalone, and stiripentol. It is low-moderate for Epidiolex. Molecular tests can predict severe reactions. Summary: Skin reactions are a relatively common side effect of ASMs with aromatic ASMs having the greatest risk. Identifying and informing high-risk patients when to seek medical attention, stopping the culprit ASM when a severe reaction looks possible, and providing appropriate medical triage can reduce morbidity and mortality from severe skin and systemic reactions. [ABSTRACT FROM AUTHOR]

Ying Zhao, Jing Tian, Cuie Gao, Lu Liu, Linxin Pan, Zhiqiang Song Department of Dermatology, Southwest Hospital, Army Medical University, Chongqing, People’s Republic of ChinaCorrespondence: Zhiqiang Song, Department of Dermatology, Southwest Hospital, Army Medical University, No. 30, Gaotanyan Street, Shapingba District, Chongqing, 400038, People’s Republic of China, Email drsongzq@hotmail.comBackground: Blood eosinophilia is often associated with various dermatoses, such as atopic eczema, urticaria, drug eruption, bullous pemphigoid, and hypereosinophilic syndrome (HES). Differential diagnosis is very challenging due to the similarities of clinical and pathological characteristics.Purpose: To investigate and analyze the clinical characteristics of dermatoses associated with blood eosinophilia (DABE) to further optimize disease management.Patients and Methods: We conducted a retrospective analysis on 397 DABE patients with blood absolute eosinophil count (AEC) greater than or equal to 0.5× 109/L. Clinical characteristics, laboratory values, treatment course, and associated diagnoses were evaluated. All DABE patients were grouped based on the severity of eosinophilia as mild group (0.5 ≤ AEC× 109/L < 1.5), moderate group (1.5 ≤ AEC× 109/L < 3), and severe group (AEC× 109/L ≥ 3).Results: Our study revealed three distinct patterns: (1) Mild eosinophilia associated with localized skin lesions, atopic history, mildly elevated total serum IgE level, diagnosed with eczema/dermatitis, and frequent antihistamines use. (2) Moderate eosinophilia has the characteristics of both mild group and severe group. (3) The severe eosinophilia group had a high proportion of elderly people without atopic history, but with acute onset, generalized skin lesions, and high level of lactate dehydrogenase, and the majority of them were diagnosed with systemic diseases (HES or tumor).Conclusion: We summarize the clinical rules of dermatoses associated with blood eosinophilia, hoping to facilitate the diagnosis and treatment for patients.Keywords: eosinophilia, diagnosis, eczema, psoriasis, drug eruption

Abstract The drug lisdexamfetamine is now widely used in the treatment of attention‐deficit hyperactivity disorder (ADHD) and there have been patient reports of skin eruptions after taking this drug. Here, we present the case of a patient with ADHD who was started on lisdexamfetamine and then presented with recrudescent acne.

Apalutamide is an antiandrogen used to treat prostate cancer. Although it sometimes induces mild cutaneous adverse events and occasionally severe ones, clinical differences between severe and mild cases remain unclear. To assess the risks in patients experiencing apalutamide‐related cutaneous adverse events (ARCAEs), we aimed to characterize severe and mild ARCAEs in terms of onset time and lymphocyte transformation test (LTT) for apalutamide. We reviewed 41 ARCAE cases: 24 from our institute and 17 from the literature, comprising (i) eight severe cases including six with toxic epidermal necrolysis, one with acute generalized exanthematous pustulosis, and one with drug reaction with eosinophilia and systemic symptoms, and (ii) 33 mild cases. Patients with evere cases developed ARCAEs significantly earlier than patients with mild cases (5.2 vs 9.6 weeks). No severe cases appeared ≥8 weeks after initiation of apalutamide. LTTs showed positive results in two of seven mild cases (28.6%) and four of four severe cases (100.0%). In conclusion, we found that severe ARCAEs are characterized by earlier onset and LTT positivity. Dermatologists and urologists should pay special attention to patients who develop ARCAEs <8 weeks after initiating apalutamide and/or show positive LTT results. [ABSTRACT FROM AUTHOR]

Background: Graves’ disease (GD) and drug eruption are closely associated and frequently observed in the clinical setting. However, it remains unclear whether a causal relationship exists between these two conditions. The aim of the study is to investigate whether GD is causal to drug eruptions using two-sample Mendelian randomization. Methods: We launched a two-sample MR to investigate whether GD is causal to drug eruption using Genome-wide association study (GWAS) summary data from Biobank Japan and FinnGen. Genetic variants were used as instrumental variables to avoid confounding bias. Statistical methods including inverse variance weighted (IVW), weighted median, MR-Egger, and MR-PRESSO were conducted to identify the robustness of the causal effect. Results: Genetically predicted GD may increase the risk of drug eruption by 30.3% (OR=1.303, 95% CI 1.119-1.516, p<0.001) in the Asian population. In European populations, GD may increase the generalized drug eruption by 15.9% (OR=1.159, 95%CI 0.982-1.367, p=0.080). Conclusions: We found GD is potentially causal to drug eruption. This finding expanded the view of the frequently observed co-existence of GD and adverse drug reactions involving the skin. The mechanism remains for further investigation. [ABSTRACT FROM AUTHOR]

Hongxia Jia, Liwei Ran Department of Dermatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Liwei Ran, Department of Dermatology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel +86 010 85231374, Email wlbrlw@163.comAbstract: A 76-year-old male developed a maculopapular rash on his trunk and extremities. The rash appeared 2 months after Finasteride administration for his prostatic hyperplasia. Clinical suspicion was of drug exanthema due to Finasteride. The clinical and histologic data were compatible with pharmacologic eruption by Finasteride.Keywords: maculopapular, drug eruption, Finasteride

Background: Toxic epidermal necrolysis (TEN) is the most severe form of drug eruption, necessitating intensive care management in several cases. Although guidelines have been established for diagnosing and treating skin symptoms, few studies have reported on the intensive care management and prognosis of TEN. This study aimed to investigate intensive care for various types of organ failure associated with TEN and their prognoses. Methods: This retrospective, descriptive, single-center study included patients admitted to our intensive care unit (ICU) for treatment of TEN over a 10-year period. We investigated the participants’ characteristics, organ failure and management, duration of ICU and hospital stay, and prognosis, through the electronic medical and ICU progress records. Results: This study enrolled eight patients. Most patients presented with multiple organ failure, and in-hospital mortality was 50%. The median SOFA score at ICU admission was 9.5, and the median maximum SOFA score during ICU stay was 16.0. All patients underwent mechanical ventilation. Renal replacement therapy was administered to five patients. The median length of stay in the ICU was 31.5 days, and the median duration of hospitalization was 87 days. Survivors required long-term hospitalization, and only one patient was discharged home. Conclusions: Most TEN patients admitted to the ICU had multiple organ failure, and poor short- and long-term prognoses.

Background: Evidence of factors associated with Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) from population-based studies is scarce. Objective: We aimed to identify the incidence, risk factors, and drugs that trigger the development of SJS/TEN in the general population. Methods: A regional, population-based, longitudinal cohort with 2,398,393 Japanese individuals was analyzed using the Shizuoka Kokuho Database from 2012 to 2020. Results: Among 1,909,570 individuals, 223 (0.01%, 2.3 cases/100,000 person-years) patients were diagnosed with SJS/TEN during the observational period of a maximum of 7.5 years. In a multivariable analysis, the risks of SJS/TEN were an older age, and the presence of type 2 diabetes, peripheral vascular disease, and systemic autoimmune diseases. The administration of drugs, such as immune checkpoint inhibitors, insulin, and type 2 diabetes agents, triggered the onset of SJS/TEN. Limitations: The results may apply only to the Japanese population. Conclusion: In this cohort population from a database representing the general population, the risks of developing SJS/TEN were old age and a history of type 2 diabetes, peripheral vascular disease, and systemic autoimmune disease. Furthermore, in addition to previously reported drugs, the administration of immune checkpoint inhibitors, insulin, and type 2 diabetes agents, may trigger the development of SJS/TEN.

Abstract is missing (Short communication)

Olaparib is recently approved as an anti-tumor agent for several cancers, including castration-resistant prostate cancer, which inhibits poly (adenosine diphosphate-ribose) polymerase, a DNA repair factor. Since olaparib is a newly approved drug, there are few reports of skin disorders that may be triggered by olaparib administration. In this report, we present a case with an olaparib-induced drug eruption presenting multiple purpuras on the patient’s fingers and fingertips. The present case suggests that olaparib might induce purpura as nonallergic drug eruption.

Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) or drug-induced hypersensitivity syndrome (DIHS) is a severe skin reaction associated with general symptoms and mortality reaching up to 10% of cases. DRESS/DIHS is one of the few dermatological emergencies which need to be taken into consideration when dealing with a patient with acute exanthema and systemic symptoms like: fever, lymphadenopathy, muscle pain, hepatosplenomegaly, abnormal blood count results and systemic inflammation. The aim of this article is to summarize the literature finding regarding this dermatological emergency and present the case of a 42-year-old male suffering from DRESS syndrome as a consequence of sulfasalazine intake due to an inflammatory bowel disease, who was effectively treated with oral prednisolone and immediate drug withdrawal.

Key Clinical Message: Hydroxychloroquine (HCQ) has been reported to cause pustular drug eruptions such as acute generalized exanthematous pustulosis (AGEP) and putular psoriasis (PP). Clinical differentitation of these entities is often difficult. This case emphasizes characteritics of AGEP and PP as well as the need for clinicans to proactively follow‐up these patients to monitor for the more aggressive outcome of PP. [ABSTRACT FROM AUTHOR]

Bangladesh Cutaneous Adverse Drug Responses (CADR) are common adverse drug reactions that can manifest in many ways and range in severity. The most typical drug allergy symptom is skin manifestation, underscoring how crucial it is to identify the offending medication and stop using it doing so could even save your life in some cases. Objective This study aims to investigate the incidence of severe and fatal cutaneous adverse medication reactions (SCAR) in hospitalized Bangladeshi patients and the prevalence of severe and fatal cutaneous adverse drug reactions (SCAR) in hospitalized patients. Methods Inpatient records from the Department of Dermatology and Venereology, Combined Military Hospital (CMH), Dhaka, were used to gather data retroactively throughout the time frame of January 2012 to December 2016. Age, gender of the patients, implicated drugs, observed drug reactions, course of treatment, and results were some variables we examined (mortality and morbidity). Results Clinical evaluation of the study participants revealed that 46% of cases were SJS, 29% were TEN, 16% were DRESS, and 10% were AGEP. The age range of 31 to 50 years saw the highest incidence (46%) of cases. Drug classes that contain anticonvulsants may have the highest incidence of SCADRs. Phenytoin caused 16% of patients' SCADRs, followed by carbamazepine in 22% of instances and phenobarbital in 14% of cases. Conclusion SCADRs have been a serious issue in healthcare for decades. The majority of SCADR is caused by medications that doctors give. SCADRs were more frequently observed with anticonvulsants from the carbamazepine and phenytoin categories. Continuous monitoring of SCADRs is necessary to develop preventive measures. [ABSTRACT FROM AUTHOR]

Toxic erythema of chemotherapy (TEC) is an infrequently reported cutaneous condition, with diagnosis predominately based on clinical presentation, histologic findings, and known reported associations. Therefore, it is important to both recognize common presentations of TEC and be mindful of chemotherapeutic agents associated with this cutaneous side effect to prevent misdiagnosis and prolonged time to treatment. Herein, we present a patient with TEC occurring in intertriginous skin (malignant intertrigo) with classic clinical and histologic findings. In our patient this was associated with a combination neoadjuvant gemcitabine and paclitaxel therapy, a relationship that, to our knowledge, has yet to be reported in the literature.

Abstract Background Recent studies suggest potential roles of immune response in the pathophysiology of epilepsy. Anti-seizure medications (ASMs) are known to have side effects of drug eruption caused by immune responses. A few reports in adults have demonstrated disappearance of seizures after an ASM drug eruption episode. In this paper, we described 2 cases of childhood absence epilepsy (CAE) who showed seizure disappearance after ethosuximide (ESM) drug eruption, suggesting the possibility that the epilepsy disappears due to immune responses to ASM. Case presentation Case 1 was an 8-year-old girl diagnosed with CAE. She was treated with valproate acid (VPA) initially, and then ESM was administered as an additional treatment. Her epileptic seizure disappeared 4 days after initiation of ESM. However, drug eruption appeared 1 week after the administration of ESM. Even after discontinuation of ESM administration, she maintains no seizure after the drug eruption. Case 2 was a 5-year-old boy diagnosed as CAE. He was treated with VPA initially, and ESM was administered additionally. Drug eruption appeared 1 month after the administration of ESM. Even after ESM was terminated, he maintained seizure freedom after the appearance of eruption. Conclusions Epileptic seizures may have been suppressed due to the immune responses caused by ASM eruption. Further studies are needed to elucidate the pathophysiologic effects of drug eruption on epilepsy through immune responses.

Lichen planus is a chronic, inflammatory, immune-mediated dermatosis affecting the patient’s skin, scalp, mucous membranes, and nails. Drug-induced lichen planus is described after the administration of antimalarials, ß-blockers, methyldopa, NSAIDs, penicillamines, and sodium aurothiomalate. The use of biologicals such as adalimumab, etanercept, and infliximab has also been linked with the appearance of lichenoid eruptions in the recent past. In this case, we report on a patient developing oral and cutaneous lichen planus after the administration of dupilumab. The lichenoid lesions occurred after 11 months of the drug’s administration and involved the buccal walls, trunk, and extremities. Dupilumab had been administered in an effort to counter severe atopic dermatitis exacerbations. Dupilumab is associated with a downregulation of T-helper 2 cell activation by blocking the Interleukin-4/Interleukin-13 pathway, so leading to a TH1/TH2 imbalance. This imbalance may cause a shift toward a TH1-mediated immune response and be an explanation for the drug-induced lichen planus. Dupilumab was discontinued, and the patient was treated with oral corticosteroids and UVB phototherapy, leading to a significant improvement in the lichen planus lesions.

Abstract Erythema exudativum multiforme (EM), Stevens‐Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) are acute inflammatory diseases of the skin and mucous membranes. EM with mucosal eruptions is sometimes difficult to differentiate from SJS or TEN. This study aimed to understand the characteristics of these diseases by evaluating the backgrounds, clinical symptoms, and disease courses of EM/SJS/TEN patients treated at our hospital. It shows that persistent fevers and erosion are common in SJS/TEN. Therefore, we must pay attention to whether they become more severe.

Bullous Fixed drug eruption (BFDE) is a form of skin and mucocutaneous allergic reaction formed as purplish plaque or bullae with purple base in the same previous place due to certain medication. One of the drug is known to trigger FDE is non-steroidal antiinflammation drugs (NSAIDs) including mefenamic acid. Clinically, FDE is often mimic Steven-Johnson syndrome with milder clinical symptoms. A 24-year-old male came with complaint of multiple red spots with blisters and itch on his trunk, back, and leg. He also complained about his white painful scaled lip and lesion in his mouth since 1 day ago after he took mefenamic acid. The patient had the same complaint 1 year ago. Dermatological status showed multiple purpuric annular and oval well-demarcated lesions and tension bullae on his back and right leg. Less-demarcated erythema lesion were seen on his trunk. On his lips there were oedema with white desquamation and white lesions on his tongue along with multiple intraoral erosion. Blood examination showed good results. The patient was diagnosed with bullous fixed drug eruption and was treated with methylprednisolone injection 2x62,5mg with gradual tapering-off, ranitidine injection 2x50mg, and ringer lactate fluid 500cc per 12 hour. In 3 days the patient showed clinical improvement. Clinical manifestations of bullous fixed drug eruption are often mimic other dermatosis and can be differentiate with history of taking triggering medication and the place of the lesions. Education according drug-induced allergy is essential to prevent lesions recurrency.. [ABSTRACT FROM AUTHOR]

Background Recognition of parameters to predict severity of drug eruptions can be helpful in early intervention in severe cases. In this study, we evaluate the role of hematological factors including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte (PLR) ratio in prediction of severity in cutaneous drug reactions. Methods This is a retrospective cross-sectional study on 46 hospitalized patients with drug eruptions and 46 healthy individuals as control group. NLR/PLR was compared between patients with drug eruptions and healthy control group by independent t test. Moreover, the values of these hematological markers were compared between serious and non-serious types of drug eruptions by independent t test. Results Serious drug eruptions constitute nearly one-fourth of total drug eruptions. The mean values of NLR in case and control groups were 3.91±2.87 and 2.30±1.62, respectively (P=0.001). The mean values of PLR in case and control groups were 155.35±90.60 and 125±45.64, respectively (P=0.045). Females with drug eruptions had significantly higher PLR compared to males (P=0.02). Furthermore, there was no significant correlation between NLR/PLR in serious and non-serious types of drug reactions. Conclusion NLR/PLR was significantly higher in patients with drug eruptions compared to control group. There was no significant correlation between NLR/PLR with either demographic features of patients or severity of drug eruption; except significantly higher PLR in female with drug eruptions compared to males. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To present the case of a Latin man 68 years of age who presented to the emergency department with a rash to the right side of his groin 10 weeks after switching from simvastatin 40 mg daily to atorvastatin 40 mg daily. BACKGROUND: Prior to switching to atorvastatin, the patient had been taking simvastatin for 21 years without rash. The rash progressed bilaterally to his arms and hands, legs, buttocks, back, and trunk before the patient was seen by dermatology and atorvastatin was discontinued. RESULTS: Within six weeks of discontinuation of atorvastatin, the rash resolved with remaining pigmentation changes. The adverse effect was documented in the patient's chart, and dermatology recommended avoiding other statins in the future. SETTINGS: Ambulatory clinic pharmacy practice, emergency room, or urgent care centers. PRACTICE CONSIDERATIONS: Atorvastatin is a 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMGCoA) reductase inhibitor or statin that has been FDA approved for the prevention of atherosclerotic cardiovascular disease (ASCVD) and treatment of hypercholesterolemia since 1996. Despite widespread use of atorvastatin over many years, only a handful of published cases report drug eruption from its use. Previous case reports have found that retrial of statins may cause similar drug eruption. CONCLUSION: Pharmacists should consider HMG-CoA reductase inhibitors as a possible cause of new onset rash and should not retrial an alternative statin. [ABSTRACT FROM AUTHOR]

Key Clinical Message Hydroxychloroquine (HCQ) has been reported to cause pustular drug eruptions such as acute generalized exanthematous pustulosis (AGEP) and putular psoriasis (PP). Clinical differentitation of these entities is often difficult. This case emphasizes characteritics of AGEP and PP as well as the need for clinicans to proactively follow‐up these patients to monitor for the more aggressive outcome of PP.

This article, published in the Journal of the Turkish Academy of Dermatology, discusses a case of lichenoid drug eruption (LDE) in a male patient following administration of the Pfizer-BioNTech COVID-19 mRNA vaccine. The patient presented with a generalized itchy rash, and physical examination revealed multiple papules and plaques on various parts of the body. Histopathological examination confirmed the diagnosis of LDE triggered by the COVID-19 vaccine. The article highlights that while cutaneous reactions to COVID-19 vaccines are being extensively studied, lichenoid reactions are uncommon but have been reported. The exact mechanism behind these reactions is not yet clear, but it is suggested that the viral component of the vaccines may trigger a cell-mediated immune response. The authors emphasize the importance of dermatologists being able to diagnose and treat cutaneous adverse reactions related to COVID-19 vaccines. [Extracted from the article]

Erythroderma or exfoliative dermatitis is a cutaneous disease characterized by erythema and scaling affecting more than 90% of body surface area. This can be resulted from malignancy, drug eruption, idiopathic and underlying disease like psoriasis, atopic dermatitis and seborrhoic dermatitis. Patients with HIV/AIDS are prone to drug eruption. A 50 year old man presented to our outpatient clinic with exfoliative scaly skin all over his body after consuming anti-TB therapy. He was diagnosed with lung tuberculosis (TB), human immunodeficiency virus (HIV) infection stage 3. Histopathological examination revealed mild acanthosis and spongiosis in the epidermis, dropping melanin, lymphocyte, histiocyte and perivascular polymorphonuclear (PMN) leukocytes in the dermis. We treated this patient by discontinuing his anti-TB drug, the suspected causative drug, hydrating with intravenous fluid, placing him in warm room and covering him with thin blanket. He was treated with methylprednisolone IV 62.5 mg/24 hours for 5 days, cetirizine tablet 10 mg once daily, topical vaselin applicative twice per day, gentamicin ointments applied on the erosive area twice daily and extra egg white diet 1700 kcal. Our patient's condition improved after discontinuing anti-TB drugs and receiving systemic corticosteroid as well as topical emollient. Erythroderma due to the first line antitubercular drug is uncommon. It can lead to a serious potentially life threatening problem. Therefore early recognition, early diagnosis and early treatment determine the outcome. [ABSTRACT FROM AUTHOR]

Background: Recent studies suggest potential roles of immune response in the pathophysiology of epilepsy. Anti-seizure medications (ASMs) are known to have side effects of drug eruption caused by immune responses. A few reports in adults have demonstrated disappearance of seizures after an ASM drug eruption episode. In this paper, we described 2 cases of childhood absence epilepsy (CAE) who showed seizure disappearance after ethosuximide (ESM) drug eruption, suggesting the possibility that the epilepsy disappears due to immune responses to ASM. Case presentation: Case 1 was an 8-year-old girl diagnosed with CAE. She was treated with valproate acid (VPA) initially, and then ESM was administered as an additional treatment. Her epileptic seizure disappeared 4 days after initiation of ESM. However, drug eruption appeared 1 week after the administration of ESM. Even after discontinuation of ESM administration, she maintains no seizure after the drug eruption. Case 2 was a 5-year-old boy diagnosed as CAE. He was treated with VPA initially, and ESM was administered additionally. Drug eruption appeared 1 month after the administration of ESM. Even after ESM was terminated, he maintained seizure freedom after the appearance of eruption. Conclusions: Epileptic seizures may have been suppressed due to the immune responses caused by ASM eruption. Further studies are needed to elucidate the pathophysiologic effects of drug eruption on epilepsy through immune responses. [ABSTRACT FROM AUTHOR]