Severe cutaneous adverse reaction

Background

• Potentially life-threatening adverse drug reaction with significant skin involvement

Comparison

• From 1

SCAR	Time to Onset	Skin Findings	Other Symptoms	Investigations	Histology
SJS/TEN	4 to 28 days	Blisters, large areas of skin detachment, confluent erythema, atypical target lesions, purpura, Nikolsky sign	Flu-like febrile illness and respiratory symptoms	Lymphopenia, transitory neutropenia, mild cytolysis, AKI	Full-thickness epidermal necrosis, focal adnexal necrosis, necrotic keratinocytes, mild mononuclear cell dermal infiltrate, negative direct immunofluorescence test
DRESS	2 to 6 weeks	Maculopapular rash, erythroderma, edema of face and extremities, purpura, pustules, focal monopolar mucous membrane involvement	Flu-like febrile illness	Eosinophilia, atypical lymphocytes, ALT, AKI, herpesvirus or parvovirus reactivation	Lichenoid infiltrate or eczematous pattern (spongiosis, oedema), focal necrotic keratinocytes, mononuclear infiltrate, focal eosinophil and neutrophil infiltrates, mild vasculitis
AGEP	1 to 11 days	Intertriginous erythema, edema, widespread sterile pustules, post-pustular pinpoint desquamation, Nikosky sign, rare oral mucosal involvement	Fever	Leukocytosis, neutrophilis, mild eosinophilia	Subcorneal or intraepidermal spongiform or non-spongiform pustules with or without papillary oedema, focal necrotic keratinocytes, neutrophilic sometimes with eosinophils, mild vasculitis

Further Reading

• Severe cutaneous adverse reactions to drugs. Lancet. 2017 Oct 28;390(10106):1996-2011. doi: 10.1016/S0140-6736(16)30378-6.