Druginduced hypersensitivity syndrome typically presents with facial edema and a morbilliform rash. Morbilliform or exanthematous drug reaction maculopapular drug eruption. The photo depicts the face of a child affected by morbilliform rash. Exanthem is typically symmetric, with confluent erythematous macules and papules that spare the palms and soles. Certain patient groups table 2 appear to be at an increased risk of developing a cutaneous drug reaction.
Picture of morbilliform drug eruption drug hypersensitivity reaction. The differential diagnosis at that time included druginduced hypersensitivity syndrome, which was less likely given the lack of associated liver enzyme elevations, eosinophilia, or lymphadenopathy. Usually there is a history of recent drug therapy, the rash is of a type which is known to occur with the particular prescribed drug and. Generalized bullous fixeddrug eruption secondary to the. Histopathologic features of exanthematous drug eruptions of. Morbilliform drug eruptions, also called exanthematous drug eruptions, are a form of delayed cutaneous hypersensitivity characterized by erythematous macules or papules that coalesce to form large plaques. We present the first prospective histopathologic study of maculopapular drug eruption in 48 patients in whom the diagnosis had been made on the basis of clinical examination, history of a known offending drug, and followup. After morbilliform exanthems, fde is the most common cutaneous drug reaction. The patient was referred for dermatologic evaluation, with the consensus diagnosis being morbilliform drug eruption related to m7824 therapy. Widespread erythematous macules or papules appearing a week after drug exposure are usual. Morbilliform drug eruption exanthematous morbilliform drug eruption urticaria 1 cutaneous small vessel vasculitis lower leg hypersensitivity vasculitis drug induced erythroderma drug induced exfoliation cutaneous findings of stevensjohnson syndrome mucosal changes in stevensjohnson syndrome toxic epidermal necrolysis. Picture of morbilliform drug eruption on face the photo depicts the face of a child affected by morbilliform rash.
Severe recalcitrant morbilliform eruption from dual immune. Urticarial drug eruption due to phenobarbital or trimethoprim. The incidence of cutaneous reaction increases with the number of drugs taken. This post will cover conditions ranging from the simple drug. Morbilliform drug eruption exanthematous morbilliform drug eruption urticaria 1 cutaneous small vessel vasculitis lower leg hypersensitivity vasculitis druginduced erythroderma druginduced exfoliation cutaneous findings of stevensjohnson syndrome mucosal changes in stevensjohnson syndrome toxic epidermal necrolysis abdomen toxic epidermal. This article outlines a logical approach to identifying drug eruptions, their trigger and their management. They are characterized by a diffuse and symmetric eruption of erythematous macules or small papules occurring approximately one week or, in previously sensitized individuals, as early as one or two days after the initiation of drug. The most common type of eruption is a morbilliform resembling measles or erythematous rash approximately 90% of cases. Morbilliform rash eventually spread to the face and extremeties of the same child. The lesions is a welldemarcated erythematous plaque that may blister, tending to heal with postinflammatory hyperpigmentation. Fixed drug eruption exanthematous morbilliform drug reaction lupuserythematosuslike drug reaction c lichenoid interface drug reaction. Because more than 1 biopsy was taken in 11 patients, 60 biopsy specimens could be examined. Request pdf histopathologic features of exanthematous drug eruptions of the macular and papular type. Although it can present with pustules, the latent period is longer 26 weeks, and there frequently are signs of multiorgan involvement including hepatic dysfunction, eosinophilia, atypical lymphocytosis, and lymphadenopathy.
Urticarial drug eruption with partially clearing areas due to ceclor. They are characterized by a diffuse and symmetric eruption of erythematous macules or small papules occurring approximately one week or, in previously sensitized individuals, as early as one or two days. In a recent study of morbilliform drug eruptions, eosinophils were found in 50% and neutrophils in 36% of cases 18. Maculopapular rashes are skin eruptions that exhibit both the characteristics of a macule and papule. A fixed drug eruption is the term for a drug eruption that occurs in the same skin area every time the person is exposed to the drug. Due to the combination of a drug and ultraviolet radiation uvr, either uva 320400 nm andor uvb 290320 nm. Hsct pts with morbilliform eruptions within 100 days facial involvement more common in gvhd 36% of pts with gvhd had facepalmssoles, 0% in drug eruption cohort diarrhea more common in gvhd. Morbilliform drug eruption is a type of rash that occurs due to exposure to certain types of medications. Even more challenging is the fact that the most vulnerable populations to drug reactions are increasing and include the elderly patients on prolonged drug therapy, and patients that use multiple drugs at. Diagnosis, histopathology and therapy is an accessible resource for early detection and resolution of cutaneous drug reactions.
The skin reaction is due to hypersensitivity to a medication. Ely, md, msph, and mary seabury stone, md, university of iowa carver college of medicine, iowa city, iowa. Drug eruptions occur in up to 2% of hospitalized patients. Medications of all types, whether allopathic, homeopathic, ayurvedic, natural or traditional products in any form, regardless of the route of administration must be considered, especially new drugs taken in the first. Angioedema can also be druginduced most notably, by angiotensin converting enzyme inhibitors. Inflammation follows the release of cytokines and other effector immune cells. Exanthematous drug eruption, also called morbilliform or maculopapular drug.
The extent of interface changes varies greatly, from extensive vacuolar alteration at the dermoepidermal junction and many necrotic keratocytes at all levels of the epidermis, as in most cases of fixed drug eruption and toxic epidermal necrolysis, to focal and very. Eczematous, targetoid rash on the trunk occuring 1 week after the administration of a systemic cephalosporin. What you should be alert for in the history the onset of a morbilliform eruption mde. Eruptions can occur frequently with a certain drug for example, with phenytoin 8, or be very rare for example, sweets syndrome following the administration of colonystimulating factors 9. Overall histology is nonspecific but can help rule out other potential causes for the eruption. Approximately 9095% of all drug rashes are druginduced exanthems, or morbilliform or maculopapular drug eruptions. Biopsy can be helpful in confirming the diagnosis of a drug eruption eg, by showing eosinophils in morbilliform eruptions or numerous neutrophils without vasculitis in persons with sweet syndrome. It is mediated by cytotoxic tcells and classified as a type iv immune reaction. Drug eruptions occur in up to 2% of hopitalized patients.
Jul 31, 20 dermatopathology reference describes morbilliform drug eruption histopathology including histologic features and provides links to additional medical references. Clinical study of cutaneous drug eruptions in 200 patients. Histopathologic features of exanthematous drug eruptions of the. Morbilliform definition of morbilliform by medical dictionary. The condition initially appears on the trunk and spreads in a symmetrical pattern to the limbs and neck, and presents as a widespread rash of pinkred macules or papules, similar to other viral exanthems such as measles or rubella. Exanthematous morbilliform or maculopapular eruptions are the classic and most common type of drug hypersensitivity reaction, accounting for about 95% of all druginduced cutaneous reactions. Numerous sections were examined and certain salient features are presented in this paper. Morbilliform rash on the trunk occuring 1 week after the administration of a systemic cephalosporin. This page will be removed from your favorites links. Cutaneous drug eruptions diagnosis, histopathology and.
Picture of skin diseases and problems morbilliform drug. Medicinenet does not provide medical advice, diagnosis or treatment. The histopathology of drug eruptions was studied in an attempt to find specific changes which would be of diagnostic value. The rash consists of macular lesions that are red and usually 210 mm in diameter but may be confluent in places. Morbilliform drug eruption clinical blanchable, symmetric, widespread macular or papular eruption microscopic superficial perivascular infiltrate of lymphocytes and eosinophils mild vacuolar interface change sometimes present. Histopathology of drug eruptions general criteria, common patterns, and differential diagnosis. Patients can possibly continue to be treated through morbilliform eruptions ie, continue medication even in patients with a rash. The following medical conditions are some of the possible causes of. Histopathology of drug eruptions general criteria, common. There are many types of drug eruption, which range from a clinically mild and unnoticed rash to a severe cutaneous adverse reaction scar that may be lifethreatening. Many agents, including common antibiotics, can trigger a morbilliform drug eruption. Exanthematous drug eruption, also called morbilliform or maculopapular drug eruption, is the most common type of drug hypersensitivity reaction. We present the first prospective histopathologic study of maculopapular drug eruption in 48 patients in whom the diagnosis had been made on the basis of clinical examination, history of a known.
In this case, the affected skin areas included the face and extremeties. Morbilliform drug eruption due to trimethoprimsulfamethoxazole. Less commonly, the appearance may also be urticarial, papulosquamous, pustular, purpuric, bullous with blisters or lichenoid. Specifically, does a skin eruption due to a drug have a characteristic. The photo depicts a morbilliform rash on the trunk of a patient 1 week after administration of systemic cephalosporin.
Introduction fixed drug eruption fde is a type iv hypersensitivity reaction characterized by recurrence of lesions at identical sites with each exposure to the offending medication. This post will cover conditions ranging from the simple drug rash to the deadly dress. Diagnosis description and distinguishing features measles rubeola the rash is morbilliform meaning measleslike, a term often used to describe exanthematous drug eruptions, and is usually itchy. The target of attack may be drug, a metabolite of the drug, or a protein bonded to the drug. Soepronos textbook is available on and includes detailed information on over 600 entities and includes four dvd diskettes with highresolution images that provide a virtual dermatopathology reference and guide. Clues to the drug induced nature of the cutaneous eruption include the presence of overlapping histological reaction patterns and. Morbilliform drug eruptions are the most common form of drug reaction. Morbilliform drug eruptions are the most common type of cutaneous adverse drug eruption comprising. Litts drug eruptions and reactions manual, 16th ed, informa. For some differential diagnoses, criteria have been set forth to facilitate distinction of drug eruptions from other inflammatory skin diseases, e. David weedon ao md frcpa fcaphon, in weedons skin pathology. Lichenoid drug reaction differential diagnosis lichen planus.
It provides dermatologists, primary care physicians and all medical personnel with access to comprehensive and practical clinical information that will help them identify and appropriately. Feb 15, 2019 biopsy can be helpful in confirming the diagnosis of a drug eruption eg, by showing eosinophils in morbilliform eruptions or numerous neutrophils without vasculitis in persons with sweet syndrome. Soeprono teaches and practices dermatopathology at loma linda university, school of medicine, department of dermatology. The age of the patient also correlates with an increased risk of a cutaneous drug eruption. Inflammatory skin disease every pathologist should know. It is believed that concomitant viral infections may predispose susceptible individuals to develop an allergic morbilliform drug eruption. Morbilliform drug eruptions are often difficult to differentiate from viral exanthems. Feb 15, 2019 knowledge of the common eruption inducingmedications may help in identifying the offending drug.
Acute or subacute adverse cutaneous reactions to a drug or medicine include drug eruptions. Morbilliform drug eruptions exanthematous drug eruption. Morbilliform drug eruption is a form of allergic reaction. The differential diagnosis at that time included drug induced hypersensitivity syndrome, which was less likely given the lack of associated liver enzyme elevations, eosinophilia, or lymphadenopathy. Morbilliform and urticarial drug eruptions clinical gate. The eruption often resolves, especially if the individual is being treated with antihistamines. See detailed information below for a list of 30 causes of morbilliform rash, symptom checker, including diseases and drug side effect causes.
Cbc count with differential may show leukopenia, thrombocytopenia, and eosinophilia in patients with serious drug eruptions. Histopathologic features of exanthematous drug eruptions. The eruption usually occurs 5 days to 2 weeks after administration of the causative agent. The careful analysis of drug exposure must be undertaken in order to identify the causative drug of the suspected drug eruption. In our study of maculopapular drug eruptions in which the eliciting agents were known, the numbers. Morbilliform definition of morbilliform by medical. Unlike most drug eruptions, the rash seen in measles often begins on the head and neck and spreads rapidly. The term morbilliform refers to a rash that looks like measles. The most common histopathologic pattern of drug eruptions is a vacuolar interface dermatitis. Macules are small, circumscribed and discolored spots on the skin. Exanthematous morbilliform or maculopapular eruptions are the classic and most common type of drug hypersensitivity reaction, accounting for about 95% of all drug induced cutaneous reactions.
Clues to the druginduced nature of the cutaneous eruption include the presence of overlapping histological reaction patterns and. Morbilliform drug eruptions, also called exanthematous drug eruptions, are a form of delayed cutaneous hypersensitivity characterized by erythematous macules or. Although the temporal link between initiation of drug therapy and the onset of the drug rash is critical to the diagnosis, drug reactions may also occur during the course of chronic drug ingestion. Owner of adrac gmbh, a company devoted to drug hypersensitivity analysis and. Histopathology of drug eruptions jama dermatology jama. A morbilliform rash is a rosered flat or slightly elevated maculopapular eruption, showing circular or elliptical lesions varying in diameter from 1 to 3 mm, with healthylooking skin intervening. Diffuse pustular eruption following computed tomography. Even more challenging is the fact that the most vulnerable populations to drug reactions are increasing and include the elderly patients on prolonged drug therapy, and patients that use multiple drugs at the same time. May 04, 2020 morbilliform rash, or measleslike maculopapular skin eruption, is commonly caused by certain drug reactions or viral diseases. The extent of interface changes varies greatly, from extensive vacuolar alteration at the dermoepidermal junction and many necrotic keratocytes at all levels of the epidermis, as in most cases of fixed drug eruption and toxic epidermal. Knowledge of the common eruption inducingmedications may help in identifying the offending drug. Exanthematous maculopapular drug eruption uptodate. In a recent study of morbilliform drug eruptions, eosinophils were found in 50% and neutrophils in 36% of cases. Cutaneous drug reactions compromise approximately 3% of all drug reactions.
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