Bullous Drug Reactions

• Published in: Acta dermato-venereologica 2020-02, Vol.100 (5), p.adv00057-134
• Main Author: Mockenhaupt, Maja
• Format: Article
• Language: English
• Subjects: Biopsy, Needle; Drug Eruptions - epidemiology; Drug Eruptions - etiology; Drug Eruptions - immunology; Female; generalized bullous fixed drug eruption; Germany; Humans; Immunohistochemistry; Immunomodulation; Incidence; Male; Prognosis; Review; Risk Assessment; severe cutaneous adverse reaction; Severity of Illness Index; Skin Diseases, Vesiculobullous - chemically induced; Skin Diseases, Vesiculobullous - epidemiology; Skin Diseases, Vesiculobullous - pathology; Skin Diseases, Vesiculobullous - therapy; stevens-johnson syndrome; Stevens-Johnson Syndrome - epidemiology; Stevens-Johnson Syndrome - etiology; Stevens-Johnson Syndrome - pathology; Stevens-Johnson Syndrome - therapy; toxic epidermal necrolysis; Treatment Outcome
• ISSN: 1651-2057; 0001-5555; 1651-2057
• DOI: 10.2340/00015555-3408

Bullous drug eruptions are infrequent, but because they pose a challenge both to affected patients and to treating physicians they are considered to be the most severe cutaneous adverse reactions (SCAR). It is important to recognize these conditions and to differentiate them from other clinical entities involving blister formation. There may be early signs and symptoms that indicate a severe bullous drug eruption even before blisters and erosions of the skin and mucous membranes become obvious. Once the diagnosis is suspected, appropriate diagnostic procedures and adequate management must be initiated. The latter includes identification of the potentially inducing drug, although it should be taken into account that not all cases of bullous eruptions are drug-induced. In cases with drug causality the potentially culprit agent must be withdrawn, while in cases with other aetiology the underlying condition, e.g. an infection, must be treated appropriately. In addition to best supportive care, immunomodulating therapy may be considered.