Bullous pemphigoid is characterized by large, tense bullae, but may begin as an urticarial eruption. Given the different histopathological features of the EM, SJS and TEN, we decided to discuss them separately. Nature. 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]. 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 action of antithyroid drugs may be delayed in amiodarone-induced thyrotoxicosis because of substantial quantities of preformed thyroid hormones stored in the gland. Apoptosis as a mechanism of keratinocyte death in toxic epidermal necrolysis. 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. CAS Some of these patients undergo spontaneous resolution. Amphotericin B injection and potassium-depleting agents: When corticosteroids are administered concomitantly with potassium-depleting agents (ie, amphotericin B, diuretics), patients should be observed closely for development of hypokalemia.There have been cases reported in which concomitant . Frequently reported adverse events of rebamipide compared to other drugs for peptic ulcer and gastroesophageal reflux disease. 1. GULIZ KARAKAYLI, M.D., GRANT BECKHAM, M.D., IDA ORENGO, M.D., AND TED ROSEN, M.D. 2011;128(6):126676. Paquet P, Pierard GE. [117] described a cohort of ten patients affected by TEN treated with a single dose of etanercept 50mg sc with a rapid and complete resolution and without adverse events. Eur J Clin Microbiol Infect Dis. Khalil I, et al. In vitro diagnostic assays are effective during the acute phase of delayed-type drug hypersensitivity reactions. Fernando SL. Fritsch PO. Mawson AR, Eriator I, Karre S. StevensJohnson syndrome and toxic epidermal necrolysis (SJS/TEN): could retinoids play a causative role? Jang E, Park M, Jeong JE, Lee JY, Kim MG. Sci Rep. 2022 May 12;12(1):7839. doi: 10.1038/s41598-022-11505-0. 2012;42(2):24854. 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 In EMM their efficacyis demonstrated in controlling the evolution of the disease [106]. Moreover Mawson A and colleagues hypothesized that the efficacy of plasmapheresis is able to reduce serum level of vitamin A. Mucosal involvement could achieve almost 65% of patients [17]. 2007;48(5):10158. Skin testing and patch testing in non-IgE-mediated drug allergy. Anti-Allergic Agents Immunoglobulin E Allergens Cetirizine Histamine H1 Antagonists, Non-Sedating Histamine H1 Antagonists Loratadine Emollients Nasal Decongestants Dermatologic Agents Leukotriene Antagonists Antigens, Dermatophagoides Ointments Histamine Antagonists Eosinophil Cationic Protein Adrenal Cortex Hormones Terfenadine Antipruritics Antigens, Plant . 2010;88(1):608. It should be used only in case of a documented positivity of cultural samples. The authors wish to thank Dr. Gary White for the picture of EM showed in Fig. 2011;18:e12133. See this image and copyright information in PMC. De Araujo E, et al. The approach to treatment should include discontinuation of any potentially causative medications and a search for any underlying malignancy. Umbilical cord mesenchymal stem cell transplantation in drug-induced StevensJohnson syndrome. Furosemide or ethacrynic acid may be required to maintain an adequate urinary output [90]. Mortality rate of patients with TEN has shown to be directly correlated to SCORTEN. 2015;13(7):62545. d. Cysts and tumors. . Erythema multiforme and toxic epidermal necrolysis. 2010;163(4):84753. Clin Exp Allergy. 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. Normal epidermis undergoes some exfoliation every day, but the scales that are lost contain little, if any, important viable material, such as nucleic acids, soluble proteins and amino acids.4 In exfoliative dermatitis, however, protein and folate losses may be high.5, The pathogenesis of exfoliative dermatitis is a matter of debate. Abstract Acute interstitial nephritis associated with hepatitis, exfoliative dermatitis, fever and eosinophilia is uncommon. Typical target lesions consist of three components: a dusky central area or blister, a dark red inflammatory zone surrounded by a pale ring of edema, and an erythematous halo on the periphery. Talk to our Chatbot to narrow down your search. Gastric protection. An extremely rare mucocutaneous adverse reaction following COVID-19 vaccination: Toxic epidermal necrolysis. New York: McGraw-Hill; 2003. p. 54357. Drug induced exfoliative dermatitis: state of the art, https://doi.org/10.1186/s12948-016-0045-0, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. N Engl J Med. Increased level of retinoid acid could be responsible for keratinocytes apoptosis [99]. Other patients may warrant PUVA (psoralen plus ultraviolet A) phototherapy, systemic steroids (if psoriasis has been ruled out), retinoids (for exfoliative dermatitis secondary to psoriasis and pityriasis rubra pilaris), or immunosuppressive agents such as methotrexate (Rheumatrex) and azathioprine (Imuran).2527, When used as adjunctive therapy, behavior modification designed to eliminate persistent scratching has been successful in reducing the rate of excoriation and increasing the rate of healing.28. . Erythema multiforme and toxic epidermal necrolysis. HLA DQB1* 0301 allele is involved in the susceptibility to erythema multiforme. 1993;129(1):926. Antiviral therapy. Erythema multiforme and toxic epidermal necrolysis: a comparative study. J Allergy Clin Immunol. (scFv) (directed against Dsg1/3) or AK23 (directed against Dsg3) with (as a control) or without exfoliative toxin A (ETA). 2012;66(6):9951003. . Rzany B, et al. Schneck J, et al. 2010;62(1):4553. 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. In: Eisen AZ, Wolff K, editors. (sometimes fatal), erythema multiforme, Stevens-Johnson syndrome, exfoliative dermatitis, bullous dermatitis, drug rash with eosinophilia and systemic symptoms (DRESS . Schwartz RA et al. Curr Probl Dermatol. Toxic epidermal necrolysis: Part I Introduction, history, classification, clinical features, systemic manifestations, etiology, and immunopathogenesis. This content is owned by the AAFP. Drug induced exfoliative dermatitis (ED) are a group of rare and severe drug hypersensitivity reactions (DHR) involv ing skin and usually occurring from days to several weeks after drug exposure. Would you like email updates of new search results? [Stevens-Johnson Syndrom and Toxic Epidermal Necrolysis--based on literature]. In contrast with DRESS, eosinophilia and atypical lymphocytes are not described in patients with SJS or TEN. Erythema multiforme (EM), StevensJohnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. Immunoregulatory effector cells in drug-induced toxic epidermal necrolysis. -. Bastuji-Garin S, et al. Article 2013;168(3):53949. What are Drug Rashes? This is due to a reaction to certain medicines, a pre-existing skin condition, and sometimes cancer. (2.4, 5.6) Embryo-fetal Toxicity: Can cause fetal harm. Cho YT, et al. Copyright 1999 by the American Academy of Family Physicians. Erythroderma is a rare but severe Adverse Drug Reaction (ADR) of phenytoin. Drug rashes are the body's reaction to a certain medicine. The authors concluded for a potential beneficial effect of Cys A and a possible improvement in survival compared to IVIG. These include a cutaneous reaction to other drugs, exacerbation of a previously existing condition, infection, metastatic tumor involvement, a paraneoplastic phenomenon, graft-versus-host disease, or a nutritional disorder. 1984;101(1):4850. Mockenhaupt M, et al. Part of Clinicians using antivirals for mpox should be alert for drug-drug interactions with any antiretrovirals used to prevent 16, 17 or treat 18 HIV infection as well as with any other medications used to prevent or treat HIV-related opportunistic infections. SJS and TEN are two overlapping syndromes resembling severe burn lesions and characterized by skin detachment. Retrospective review of StevensJohnson syndrome/toxic epidermal necrolysis treatment comparing intravenous immunoglobulin with cyclosporine. Clinical, etiologic, and histopathologic features of StevensJohnson syndrome during an 8-year period at Mayo Clinic. Schopf E, et al. The administration of a single dose of 5mg/kg was able to stop disease progression in 24h and to induce a complete remission in 614days. Apoptosis-inducing factors and lymphocyte-mediated cytotoxicity have been deeply investigated in ED. Stern RS. 2003 Oct 25;147(43):2089-94. Australas J Dermatol. A multidisciplinary team is fundamental in the therapeutic management of patients affected by exfoliative DHR. PubMed Central 2012;43:10115. 1998;37(7):5203. Interstitial nephritis is common in DRESS syndrome, occurring roughly in 40% of cases, whereas pre-renal azotemia may occur in SJS and TEN. of Internal Medicine, University of Bari, Bari, Italy, Andrea Nico,Elisabetta Di Leo,Paola Fantini&Eustachio Nettis, You can also search for this author in See permissionsforcopyrightquestions and/or permission requests. Nayak S, Acharjya B. Article Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Focus on the Pathophysiological and Diagnostic Role of Viruses. 2012;97:14966. Pehr K. The EuroSCAR study: cannot agree with the conclusions. The prognosis of cases associated with malignancy typically depends on the outcome of the underlying malignancy. 1). Am J Clin Dermatol. Ardern-Jones MR, Friedmann PS. A systematic review of treatment of drug-induced StevensJohnson syndrome and toxic epidermal necrolysis in children. Infliximab was used in cases refractory to high-dosage steroid therapy and/or IVIG. Toxic epidermal necrolysis: Part II Prognosis, sequelae, diagnosis, differential diagnosis, prevention, and treatment. 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]. Oliveira L, Zucoloto S. Erythema multiforme minor: a revision. Here we provide a systematic review on frequency, risk factors, pathogenesis, clinical features and management of patients with drug induced ED. Fritsch PO. A rare case of toxic epidermal necrolysis with unexpected Fever resulting from dengue virus. 2002;65(9):186170. These patches tend to spread until, after a matter of days or weeks, most of the skin surface is covered with an erythematous, pruritic eruption. 2011;20(5):103441. [49] confirmed these results and even suggested that higher dosage regimen with 2.74g/kg seem to be more effective in survival outcome. 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. 2011;38(3):23645. Corticosteroids could also reduce the amount of keratinocytes apoptosis and the activation of caspases [105]. Inhibition of toxic epidermal necrolysis by blockade of CD95 with human intravenous immunoglobulin. 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]. Management of patients with a suspected drug induced exfoliative dermatitis, acute generalized exanthematous pustulosis, algorithm of drug causality for epidermal necrolysis, European registry of severe cutaneous adverse reactions to drugs. Article Genotyping is recommended in specific high-risk ethnic groups (e.g. Exfoliative dermatitis has been reported in association with hepatitis, acquired immunodeficiency syndrome, congenital immunodeficiency syndrome (Omenn's syndrome) and graft-versus-host disease.2,1517, In reviews of erythroderma, a significant percentage of patients (about 25 percent) do not receive a specific etiologic diagnosis. 2010;85(2):131138. Chemicals and Drugs 61. 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). It is advised against the use of silver sulfadiazine because sulphonamide can be culprit agents. Google Scholar. Int J Dermatol. Exfoliative dermatitis may happen as a complication of other skin issues. Exfoliative dermatitis is a rare inflammatory skin condition that is characterized by desquamation and erythema involving more than 90% of the body surface area. Mild to severe alopecia and transient or permanent nail dystrophy also may be encountered. J Am Acad Dermatol. Toxic epidermal necrolysis: Part I Introduction, history, classification, clinical features, systemic manifestations, etiology, and immunopathogenesis. Clinical classification of cases of toxic epidermal necrolysis, StevensJohnson syndrome, and erythema multiforme. Terms and Conditions, T and NK lymphocytes can produce FasL that eventually binds to target cells. Chung WH, Hung SI. Oral hygiene with antiseptic and painkiller mouthwash (chlorhexidine+lidocaine+aluminum hydroxide) together with aerosol therapy with saline and bronchodilators can reduce upper airways symptoms. 2023 Jan 30;11(2):346. doi: 10.3390/microorganisms11020346. In more severe cases corneal protective lens can be used. Su SC, Hung SI, Fan WL, Dao RL, Chung WH. Drug-induced LPP. An official website of the United States government. Semin Dermatol. Tumor necrosis factor : TNF- seems also to play an important role in TEN [41]. Contact dermatitis from topical antihistamine . Karnes JH, Miller MA, White KD, Konvinse KC, Pavlos RK, Redwood AJ, Peter JG, Lehloenya R, Mallal SA, Phillips EJ. It is not completely clear whether EM and SJS are separate clinical entities or if they represent two different expressions of a single disease process. PubMed In approximately 25% of people, there is no identifiable cause. 2018 Jan 28;2018:9095275. doi: 10.1155/2018/9095275. 2013;69(2):173174. Wetter DA, Camilleri MJ. It is not recommended to use prophylactic antibiotic therapy. Curr Opin Allergy Clin Immunol. Association between HLA-B* 1502 allele and antiepileptic drug-induced cutaneous reactions in Han Chinese. 2013;69(2):187. The former is usually a recurring, localized eruption of the skin characterized by pathognomonic target or iris lesions, with minimal or no mucosal involvement (Fig. Google Scholar. Toxic epidermal necrolysis: effector cells are drug-specific cytotoxic T cells. doi: 10.1016/j.jaad.2013.05.003. Abe J, et al. Minerva Stomatol. Most common used drugs are: morphine, fentanyl, propofol and midazolam. 2009;151(7):5145. Adapted from Ref. Disclaimer. Int J Dermatol. erythroderma, exfoliative dermatitis, and fixed drug reactions) 4, 5 and . They usually have fever, are dyspneic and cannot physiologically feed. Oral manifestations of erythema multiforme. However, patchy, diffuse areas of postinflammatory hyperpigmentation and hypopigmentation may occur, especially in patients with darker skin.1,4 One case of posterythrodermic generalized vitiligo beginning six weeks after the onset of exfoliative dermatitis has been reported.29,30 Residual eruptive nevi and keloid formation are rare sequelae. Orphanet J Rare Dis. Unfortunately, the clinical picture does not contribute to an understanding of the underlying cause. [16] Drug-induced Liver Disease Study Group,Chinese Society of Hepatology,Chinese Medical Association. Therefore, it is important to identify and treat any underlying disease whenever possible and to remove any contributing external factors.2, Most published studies of exfoliative dermatitis have been retrospective and thus do not address the issue of overall incidence. J. Case Presentation: We report the development of forearm panniculitis in two women during the treatment with Panitumumab (6 mg/Kg intravenous every 2 weeks) + FOLFOX-6 (leucovorin, 5- fluorouracil, and oxaliplatin at higher dosage) for the . Kavitha Saravu. Paulmann M, Mockenhaupt M. Severe drug-induced skin reactions: clinical features, diagnosis, etiology, and therapy. Anticoagulation therapy. Applications of Immunopharmacogenomics: Predicting, Preventing, and Understanding Immune-Mediated Adverse Drug Reactions. CAS Exfoliative dermatitis, also known as erythroderma, is an uncommon but serious skin disorder that family physicians must be able to recognize and treat appropriately. It is also recommended to void larger vesicles with a syringe. The most common causes of exfoliative dermatitis are best remembered by the mnemonic device ID-SCALP. Ramirez GA, Yacoub MR, Ripa M, Mannina D, Cariddi A, Saporiti N, Ciceri F, Castagna A, Colombo G, Dagna L. Biomed Res Int. It is a clinical manifestation and usually associated with various underlying cutaneous disorders, drug induced reactions and malignancies. Painkiller therapy. 1996;134(4):7104. In EM a lymphocytic infiltrate (CD8+ and macrophages), associated with vacuolar changes and dyskeratosis of basal keratinocytes, is found along the dermo-epidermal junction, while there is a moderate lymphocytic infiltrate around the superficial vascular plexus [20]. Rare dermatological side effects such as alopecia, exfoliative dermatitis, xeroderma, pruritus have been reported. Schwartz RA, McDonough PH, Lee BW. Granulysin is a key mediator for disseminated keratinocyte death in StevensJohnson syndrome and toxic epidermal necrolysis. In SJS, SJS/TEN and TEN the efficacy of corticosteroids is far from being demonstrated. Synthetic bilaminar membranes with silver nitrate have also a role in skin repairing and avoid protein loss through the damaged skin [100, 101]. Combination of infliximab and high-dose intravenous immunoglobulin for toxic epidermal necrolysis: successful treatment of an elderly patient. Wu PA, Cowen EW. J Am Acad Dermatol. Correction of hyperthermia or hypothermia Antibiotic administration when underlying infection is suspected or identified as cause of exfoliative dermatitis or when a secondary skin and soft. A useful sign for differential diagnosis is the absence of mucosal involvement, except for conjunctiva. A serious cutaneous adverse drug reaction namely exfoliative dermatitis (erythroderma) is associated with isoniazid use . In postmarketing reports, cases of drug-induced hepatotoxicity have been reported in the first month, and in some cases, the first 2 months of NSAID therapy. Google Scholar. A review of DRESS-associated myocarditis. 2008;53(1):28. Dent Clin North Am. In any case all authors concluded that the blockage of FasL prevents keratinocyte apoptosis [35]. 2012;366(26):2492501. Other dermatoses associated with erythroderma are listed in Table 1.2,3,68. 2011;364(12):113443. 2005;62(4):63842. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. J Am Acad Dermatol. Google Scholar. J Dermatol. Jarrett P, et al. 1995;14(6):5589. TEN is also known as Lyell syndrome, since it was first described by Alan Lyell in 1956 [2, 60]. Pemphigus vulgaris, paraneoplastic pemphigus, bullous pemphigoid and linear IgA dermatosis have to be considered. Carrozzo M, Togliatto M, Gandolfo S. Erythema multiforme. A patch testing and cross-sensitivity study of carbamazepine-induced severe cutaneous adverse drug reactions. Gynecologist consultation is required for avoiding the appearance of vaginal phimosis or sinechias. Wetter DA, Camilleri MJ. Fitzpatricks dermatology in general medicine. These molecules may play a role in amplifying the immune response and in increasing the release of other toxic metabolites from inflammatory cells [48]. Skin testing in delayed reactions to drugs. Overall, T cells are the central player of these immune-mediated drug reactions. Exfoliative dermatitis accounts for about 1 percent of all hospital admissions for dermatologic conditions.3, Although the disease affects both men and women, it is more common in men, with an average male-to-female ratio of 2.3:1. 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. Role of nanocrystalline silver dressings in the management of toxic epidermal necrolysis (TEN) and TEN/StevensJohnson syndrome overlap. 1995;333(24):16007. ALDEN, an algorithm for assessment of drug causality in StevensJohnson Syndrome and toxic epidermal necrolysis: comparison with case-control analysis. Provided by the Springer Nature SharedIt content-sharing initiative. More than moderate, unresponsive to treatment, and which interferes with the Soldier's perfor-mance of duty. HLA-B* 5801 allele as a genetic marker for severe cutaneous adverse reactions caused by allopurinol. J Pharm Health Care Sci. 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]. 7 DRUG INTERACTIONS 7.1 PDE-5-Inhibitors and sGC-Stimulators 7.2 Ergotamine 8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy 8.2 Lactation 8.4 Pediatric Use 8.5 Geriatric Use 10 OVERDOSAGE 10.1 Signs and Symptoms, Methemoglobinemia 10.2 Treatment of Overdosage 11 DESCRIPTION 12 CLINICAL PHARMACOLOGY 12.1 Mechanism of Action 12.2 Pharmacodynamics 12. . Keywords: Paquet P, Pierard GE, Quatresooz P. Novel treatments for drug-induced toxic epidermal necrolysis (Lyells syndrome). Arch Dermatol. It is a clinical manifestation and usually associated with various underlying cutaneous disorders, drug induced reactions and malignancies. J Am Acad Dermatol. Both hyperthermia and hypothermia are reported. Locharernkul C, et al. J Clin Apher. Huang YC, Li YC, Chen TJ. loss of taste Derm: stevens-johnson syndrome, toxic epidermal necrolysis, rash, exfoliative dermatitis, hair . Napoli B, et al. Antitumour necrosis factor-alpha antibodies (infliximab) in the treatment of a patient with toxic epidermal necrolysis. f. For these reasons, patients should be admitted to intensive burn care units or in semi-intensive care units where they may have access to sterile rooms and to dedicated medical personnel [49, 88]. Archivio Istituzionale della Ricerca Unimi, Nayak S, Acharjya B. Eosinophils from Physiology to Disease: A Comprehensive Review. When it precedes cutaneous T-cell lymphoma lesions, exfoliative dermatitis becomes the presenting sign of the underlying malignancy. A central role in the pathogenesis of ED is played by CD8+ lymphocytes and NK cells. The diagnosis of GVDH requires histological confirmation [87]. 2011;20(2):10712. Fitzpatricks dermatology in general medicine. 2014;71(5):9417. In the hospital, special attention must be given to maintaining temperature control, replacing lost fluids and electrolytes, and preventing and treating infection. Br J Dermatol. HHS Vulnerability Disclosure, Help Tang YH, et al. Possible involvement of CD14+CD16+monocyte lineage cells in the epidermal damage of StevensJohnson syndrome and toxic epidermal necrolysis. MalaCards based summary: Exfoliative Dermatitis is related to holocarboxylase synthetase deficiency and dermatitis, and has symptoms including exanthema An important gene associated with Exfoliative Dermatitis is SPINK5 (Serine Peptidase Inhibitor Kazal Type 5). Kaffenberger BH, Rosenbach M. Toxic epidermal necrolysis and early transfer to a regional burn unit: is it time to reevaluate what we teach? Joint Bone Spine. Ann Allergy Asthma Immunol. Notably, Agr inhibitors have not yet been more rigorous pre-clinical testing using the established analyzed using rigorous testing with systemic applica standards for drug development. 2013;69(4):37583. Morel E, et al. 2008;14(12):134350. official website and that any information you provide is encrypted Sequelae of exfoliative dermatitis are not widely reported. California Privacy Statement, J Am Acad Dermatol. Gout and its comorbidities: implications for therapy. doi: 10.4103/0019-5154.39732. FDA Drug information Palynziq Read time: 10 mins Marketing start date: 04 Mar 2023 . PubMed Central 2019 Jan 6;59:463-486. doi: 10.1146/annurev-pharmtox-010818-021818. If it is exfoliative dermatitis that's drug induced, it's easy to treat . Toxic epidermal necrolysis and StevensJohnson syndrome. Fritsch PO. A pseudolymphoma reaction with fever, arthralgias, lymphadenopathy, hepatosplenomegaly, anemia and erythroderma may develop as a result of hypersensitivity to dapsone or antiepileptic drugs. Kreft B, et al. Despite improved knowledge of the immunopathogenesis of these conditions, immune-modulatory therapies currently used have not been definitively proved to be efficacious [49, 107], and new strategies are urgently needed.
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drug induced exfoliative dermatitis