title: Adverse cutaneous drug eruptions: current understanding.
abstract: Adverse cutaneous drug reactions are recognized as being major health problems worldwide causing considerable costs for health care systems. Most adverse cutaneous drug reactions follow a benign course; however, up to 2% of all adverse cutaneous drug eruptions are severe and life-threatening. These include acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). Physicians should be aware of specific red flags to rapidly identify these severe cutaneous drug eruptions and initiate appropriate treatment. Besides significant progress in clinical classification and treatment, recent studies have greatly enhanced our understanding in the pathophysiology of adverse cutaneous drug reactions. Genetic susceptibilities to certain drugs have been identified in SJS/TEN patients, viral reactivation in DRESS has been elucidated, and the discovery of tissue resident memory T cells helps to better understand the recurrent site-specific inflammation in patients with fixed drug eruption.
authors.affiliation: Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland. wolfram.hoetzenecker@usz.ch.
authors.forename: W
authors.initials: W
authors.lastname: Hoetzenecker
authors.affiliation: Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Nägeli
authors.affiliation: Medical Directorate, University Hospital of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: E T
authors.initials: ET
authors.lastname: Mehra
authors.affiliation: Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
authors.forename: A N
authors.initials: AN
authors.lastname: Jensen
authors.affiliation: Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland.
authors.forename: I
authors.initials: I
authors.lastname: Saulite
authors.affiliation: Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Schmid-Grendelmeier
authors.affiliation: Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Guenova
authors.affiliation: Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Cozzio
authors.affiliation: Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland. lars.french@usz.ch.
authors.forename: L E
authors.initials: LE
authors.lastname: French
mesh_terms: D056150:Acute Generalized Exanthematous Pustulosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D003937:Diagnosis, Differential; D019468:Disease Management; D003875:Drug Eruptions / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000628:therapy; D006801:Humans; D010641:Phenotype; D012867:Skin / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis / Q000209:etiology / Q000628:therapy
keywords: AGEP; Adverse cutaneous drug eruptions; DRESS; Maculopapular rash; Stevens-Johnson syndrome; Toxic epidermal necrolysis