Rheumatology (Oxford). A recent review [111] on 33 pediatric cases of TEN and 6 cases of SJS/TEN overlap showed that therapy with IVIG with a dosage of 0.251.5g/kg for 5days resulted in 0% mortality rate and faster epithelization. Adverse cutaneous drug reaction. Not responsive to therapy. EDs are serious and potentially fatal conditions. Exfoliative dermatitis is a disease process in which most, and sometimes all, of the skin is involved in erythematous inflammation resulting in massive scaling.1 A variety of diseases and other exogenous factors may cause exfoliative dermatitis. Captopril and Hydrochlorothiazide Tablet Prescribing Information A serious cutaneous adverse drug reaction namely exfoliative dermatitis (erythroderma) is associated with isoniazid use . Read this article to find out all its symptoms, causes and treatments. Combination of infliximab and high-dose intravenous immunoglobulin for toxic epidermal necrolysis: successful treatment of an elderly patient. Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. 2009;182(12):80719. J Allergy Clin Immunol. Kaffenberger BH, Rosenbach M. Toxic epidermal necrolysis and early transfer to a regional burn unit: is it time to reevaluate what we teach? Options include use of PUVA light therapy, total-body electron beam irradiation, topical nitrogen mustard, systemic chemotherapy and extracorporeal photopheresis. Exfoliative dermatitis (ED) is defined as diffuse erythema and scaling of the skin involving more than 90% of the total body skin surface area. Utility of the lymphocyte transformation test in the diagnosis of drug sensitivity: dependence on its timing and the type of drug eruption. Hum Mol Genet. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 1996;135(2):3056. Erythema multiforme. ALDEN, an algorithm for assessment of drug causality in StevensJohnson Syndrome and toxic epidermal necrolysis: comparison with case-control analysis. SSSS is characterized by periorificial face scabs, de-epithelialization of friction zones and conspicuous desquamation after initial erythroderma. Erythroderma (literally, "red skin"), also sometimes called exfoliative dermatitis, is a severe and potentially life-threatening condition that presents with diffuse erythema and scaling involving all or most of the skin surface area (90 percent, in the most common definition). 2013;69(4):37583. Overall, T cells are the central player of these immune-mediated drug reactions. J Allergy Clin Immunol. SCORTEN: a severity-of-illness score for toxic epidermal necrolysis. Drug rashes are the body's reaction to a certain medicine. Br J Dermatol. 1996;35(4):2346. Am Fam Physician. A useful sign for differential diagnosis is the absence of mucosal involvement, except for conjunctiva. Arch Dermatol. Granulysin is a key mediator for disseminated keratinocyte death in StevensJohnson syndrome and toxic epidermal necrolysis. Would you like email updates of new search results? Huang SH, et al. Therefore, the clinician should always consider drugs as a possible cause. Disclaimer. Exfoliative Dermatitis: Definition, Causes, Treatments and More 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]. 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/. EMs mortality rate is not well reported. In particular, drug induced exfoliative dermatitis (ED) are a group of rare and more severe drug hypersensitivity reactions (DHR) involving skin and mucous membranes and usually occurring from days to several weeks after drug exposure [2]. 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 . Man CB, et al. Mortality rate of patients with TEN has shown to be directly correlated to SCORTEN. Int J Dermatol. In patients who develop complications (i.e., infection, fluid and electrolyte abnormalities, cardiac failure), the rate of mortality is often high. Exfoliative dermatitis is a rare inflammatory skin condition that is characterized by desquamation and erythema involving more than 90% of the body surface area. Article Toxic epidermal necrolysis: Part I Introduction, history, classification, clinical features, systemic manifestations, etiology, and immunopathogenesis. Bastuji-Garin S, et al. FOIA Allergic rhinitis and atopic dermatitis. Medical search. Web Yamada H, Takamori K. Status of plasmapheresis for the treatment of toxic epidermal necrolysis in Japan. These highlights do not include all the information needed to use The site is secure. Exfoliative Dermatitis as a Para-neoplastic Syndrome of Prostate Schwartz RA, McDonough PH, Lee BW. 2012;366(26):2492501. 2022 May;35(5):e15416. PubMed Pfizer Receives Positive FDA Advisory Committee Votes Supporting A population-based study with particular reference to reactions caused by drugs among outpatients. Basal-cell carcinoma; Other names: Basal-cell skin cancer, basalioma: An ulcerated basal cell carcinoma near the ear of a 75-year-old male: Specialty It is also extremely important to obtain within the first 24h cultural samples from skin together with blood, urine, nasal, pharyngeal and bronchus cultures. HLA DQB1* 0301 allele is involved in the susceptibility to erythema multiforme. Skin testing in delayed reactions to drugs. Pharmacogenomics J. Common acute symptoms include abdominal pain or cramps, nausea, vomiting, and diarrhea, jaundice, skin rash and eyes dryness and therefore could mimic the prodromal and early phase of ED. The diagnosis of GVDH requires histological confirmation [87]. Sokumbi O, Wetter DA. Chemicals and Drugs 61. During the acute reaction, diagnosis of ED is mainly based on clinical parameters. In particular, a specific T cell clonotype was present in the majority of patients with carbamazepine-induced SJS/TEN and that this clonotype was absent in all patients tolerant to the drug who shared the same HLA with the SJS/TEN patients [45]. A promising and complementary in vitro tool has been used by Polak ME et al. Skin manifestations of drug allergy. The dermo-epidermal junction and epidermis are infiltrated mostly by CD8+ T lymphocytes whereas dermal infiltrate, mainly made from CD4+ T lymphocytes, is superficial and mostly perivascular [20, 51]. Some of these patients undergo spontaneous resolution. Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist. 2007;48(5):10158. It is important to take into consideration the mechanism of action of the different drugs in the pathogenesis of ED [104]. Australas J Dermatol. 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. statement and Mucosal involvement could achieve almost 65% of patients [17]. 2. Exfoliative dermatitis is characterized by generalized erythema with scaling or desquamation affecting at least 90% of the body surface area. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Dent Clin North Am. 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]. Generalized Exfoliative Dermatitis | Johns Hopkins Medicine Med Sci Monit. 2005;136(3):20516. 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. Epub 2018 Aug 22. TNF- has a dual role: interacts with TNF-R1 activating Fas pathway and activates NF-B leading to cell survival. J Am Acad Dermatol. Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the main clinical presentations of drug induced ED. In SJS and TEN mucosal erosions on the lips, oral cavity, upper airways, conjunctiva, genital tract or ocular level are frequent [60, 6870]. 2011;3(1):e2011004. The average age at onset is 55 years, although exfoliative dermatitis may occur at any time.2, Exfoliative dermatitis is the result of a dramatic increase in the epidermal turnover rate. 2012;43:10115. Morel E, et al. PMC Fritsch PO. More recently, carcinomas of the fallopian tube,12 larynx13 and esophagus14 have been reported as causes of exfoliative dermatitis. 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. d. Cysts and tumors. Accurate eye cleaning with saline solution is fundamental for the prevention of synechiae and for reducing corneal damage. The induction dosage in EMM is usually 1mg/kg/day that should be maintained until a complete control of the skin is obtained. Google Scholar. Once ED has occurred, it has to be managed in the adequate setting with a multidisciplinary approach, and every effort has to be made to identify and avoid the trigger and to prevent infectious and non-infectious complications. The exact source of FasL production has not been yet identified as different groups have postulated that the production might be sought in keratinocytes themselves [33] or in peripheral blood mononuclear cells [34]. Hypervolemia can also occur in patients with exfoliative dermatitis, contributing to the likelihood of cardiac failure.2124, In most patients with erythroderma, skin biopsies show nonspecific histopathologic features, such as hyperkeratosis, parakeratosis, acanthosis and a chronic perivascular inflammatory infiltrate, with or without eosinophils. Antiepileptic medications, antihypertensive medications, antibiotics, calcium channel blockers and a variety of topical agents (Table 2)2,3,69 can cause exfoliative dermatitis, but theoretically, any drug may cause exfoliative dermatitis. PubMed Central In approximately 25% of people, there is no identifiable cause. The strength of association with the development of SJS/TEN may vary among countries and historical periods, reflecting differences in ethnicities and prescription habits among the studied populations [6164]. Toxic epidermal necrolysis: effector cells are drug-specific cytotoxic T cells. Albumin is recommended only is albumin serum level is <2.5mg/dL. In HIV patients, the risk of SJS and TEN have been reported to be thousand-fold higher, roughly 1 per 1000 per year [19]. J Am Acad Dermatol. Medicines have been linked to every type of rash, ranging from mild to life-threatening. Studies indicate that mycosis fungoides may cause 25 to 40 percent of all cases of malignancy-related erythroderma.6,7 The erythroderma may arise as a progression from a previous cutaneous T-cell lymphoma lesion or appear simultaneously with the cutaneous T-cell lymphoma, or it may precede the appearance of the cutaneous T-cell lymphoma lesion. Recent advances in the genetics and immunology of StevensJohnson syndrome and toxic epidermal necrosis. Drug-induced hypersensitivity syndrome (DiHS) or drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug-induced reaction characterized by various symptoms: skin rash, fever, lymph node enlargement and internal organ involvement, which starts within 2 weeks to 3 months after drug initiation. Drug-induced Exfoliative Dermatitis & Eosinophils Increased: Causes 2009;29(3):51735. JDS | Journal of Dermatological Science | Vol 8, Issue 1, Pages 1-90 The therapeutic approach of EMM, SJS, TEN depends on extension of skin, mucosal involvement and systemic patients conditions. Toxic epidermal necrolysis treated with cyclosporin and granulocyte colony stimulating factor. 2000;22(5):4137. 2012;42(2):24854. PubMed What Is Exfoliative Dermatitis & How Does It Look? - SkinKraft Napoli B, et al. Antipyretic therapy. https://doi.org/10.1186/s12948-016-0045-0, DOI: https://doi.org/10.1186/s12948-016-0045-0. 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. PubMed Li X, et al. Wikizero - Basal-cell carcinoma Morel E, et al. 2012;97:14966. In recent years, clinicians have come to believe that this condition is secondary to a complicated interaction of cytokines and cellular adhesion molecules. Springer Nature. De Araujo E, et al. The efficacy of intravenous immunoglobulin for the treatment of toxic epidermal necrolysis: a systematic review and meta-analysis. However, according to a consensus definition [54], EMM syndrome has been separated from SJS/TEN spectrum. Drug induced exfoliative dermatitis: State of the art - ResearchGate Furosemide or ethacrynic acid may be required to maintain an adequate urinary output [90]. Cutaneous graft-versus-host diseaseclinical considerations and management. As described in Table3, major differential diagnosis of EM and SJS/TEN are (1) staphylococcal scalded skin syndrome (SSSS), (2) autoimmune blistering diseases and disseminated fixed bullous drug eruption, (3) others severe delayed DHR [6, 70, 82] (4) Graft versus host disease. In the hospital, special attention must be given to maintaining temperature control, replacing lost fluids and electrolytes, and preventing and treating infection. Intravenous administration is recommended. 2011;38(3):23645. The most common causes of exfoliative dermatitis are best remembered by the mnemonic device ID-SCALP. More than moderate, unresponsive to treatment, and which interferes with the Soldier's perfor-mance of duty. When less than 10% of the body surface area (BSA) is involved, it is defined SJS, when between 10 and 30% of BSA it is defined overlapping SJS/TEN, when more than 30% of BSA, TEN [2] (Additional file 1: Figure S1, Additional file 2: Figure S2). Here we provide a systematic review of frequency, risk factors, molecular and cellular mechanisms of reactions, clinical features, diagnostic work-up and therapy approaches to drug induced ED. 2013;27(5):65961. Google Scholar. The authors concluded that they couldnt demonstrate corticosteroids efficacy in monotherapy, but the use of steroid alone is not linked to an increased risk of mortality due to infective complications [108, 109]. 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. Br J Dermatol. Incidence and antecedent drug exposures. 2010;85(2):1318. [80], which consists of the determination of IFN and IL4 by ELISpot (Enzyme-linked immunospot assay), allowing to increase the sensitivity of LTT during acute DHR (82 versus 50% if compared to LPA). Stevens-Johnson syndrome and toxic epidermal necrolysis due to anticonvulsants share certain clinical and laboratory features with drug-induced hypersensitivity syndrome, despite differences in cutaneous presentations. Panitumumab Induced Forearm Panniculitis in Two Women With Metastatic Joint Bone Spine. The applications of topical cyclosporine and autologous serum have also been showed to be useful in refractory cases [103]. SJS and TEN are two overlapping syndromes resembling severe burn lesions and characterized by skin detachment. It is advised against the use of silver sulfadiazine because sulphonamide can be culprit agents. Recurrent erythema multiforme: clinical characteristics, etiologic associations, and treatment in a series of 48 patients at Mayo Clinic, 2000 to 2007. Antiviral therapy. Toxic epidermal necrolysis: Part I Introduction, history, classification, clinical features, systemic manifestations, etiology, and immunopathogenesis. N Engl J Med. Abe R, et al. 2008;14(12):134350. 19 Key critical interactions are discussed below for each mpox antiviral. Role of nanocrystalline silver dressings in the management of toxic epidermal necrolysis (TEN) and TEN/StevensJohnson syndrome overlap. Ethambutol Induced Exfoliative Dermatitis. PubMed Fitzpatricks dermatology in general medicine. Chung W-H, et al. 2010 Oct;35(7):723-8. doi: 10.1111/j.1365-2230.2009.03718.x. Applications of Immunopharmacogenomics: Predicting, Preventing, and Understanding Immune-Mediated Adverse Drug Reactions. 2006;19(4):18891. An extremely rare mucocutaneous adverse reaction following COVID-19 vaccination: Toxic epidermal necrolysis. 2016;2:14. Descamps V, Ranger-Rogez S. DRESS syndrome. 2016 Nov 15;17(11):1890. doi: 10.3390/ijms17111890. J Am Acad Dermatol. A drug eruption may start as a rash but eventually progress to more generalized exfoliative dermatitis. Drugs.com provides accurate and independent information on more than . Exfoliative dermatitis, also known as erythroderma, is an uncommon but serious skin disorder that family physicians must be able to recognize and treat appropriately. Among the anti-tubercular drugs exfoliative dermatitis is reported with rifampicin, isoniazid, ethambutol, pyrazinamide, streptomycin, PAS either singly or in combination of two drugs in some cases. Exfoliative Dermatitis Treatment & Management: Medical Care - Medscape StevensJohnson syndrome and toxic epidermal necrolysis. 2013;168(3):55562. Patmanidis K, et al. All Rights Reserved. Rarely, Mycoplasma pneumoniae, dengue virus, cytomegalovirus, and contrast media may be the causative agent of SJS and TEN [22, 6567]. The overall mortality rate is roughly 30%, ranging from 10% for SJS to more than 30% for TEN, with the survival rate worsening until 1year after disease onset [9, 1821]. Karnes JH, Miller MA, White KD, Konvinse KC, Pavlos RK, Redwood AJ, Peter JG, Lehloenya R, Mallal SA, Phillips EJ. Nutr Clin Pract. A slow acetylator genotype is a risk factor for sulphonamide-induced toxic epidermal necrolysis and StevensJohnson syndrome. MRY, MGS, EN and GC designed the study, selected scientifically relevant information, wrote and revised the manuscript. Overall, incidence of SJS/TEN ranges from 2 to 7 cases per million person per year [9, 1820], with SJS the commonest [21]. journal.pds.org.ph J Eur Acad Dermatol Venereol. Targeting keratinocyte apoptosis in the treatment of atopic dermatitis and allergic contact dermatitis. Clinical Presentations of Severe Cutaneous Drug Reactions in HIV Download Free PDF. Paradisi et al. Fitzpatricks dermatology in general medicine. Corticosteroids could also reduce the amount of keratinocytes apoptosis and the activation of caspases [105]. StevensJohnson syndrome and toxic epidermal necrolysis: the Food and Drug Administration adverse event reporting system, 2004-2013. Exfoliative dermatitis, also known as erythroderma, is an uncommon but serious skin disorder that family physicians must be able to recognize and treat appropriately. Next vol/issue Ann Intern Med. Bastuji-Garin S, et al. Theoretically, any drug may cause exfoliative dermatitis. In patients with SJS/TEN increased serum levels of retinoid acid have been found. Mayes T, et al. Skin eruptions caused by CBZ occur in 24% of the patients on this therapy and include pruritic and erythematous rashes, urticaria, photosensitivity reactions, alterations in skin pigmentation, exfoliative dermatitis, and toxic epidermal necrolysis View on Wiley ncbi.nlm.nih.gov Save to Library Create Alert Cite 12 Citations Citation Type 1993;129(1):926. Generalized exfoliative dermatitis, or erythroderma, is a severe inflammation of the entire skin surface. Frequently reported adverse events of rebamipide compared to other drugs for peptic ulcer and gastroesophageal reflux disease. N.Z. Von Hebra first described erythroderma (exfoliative dermatitis) in 1868. Eosinophils from Physiology to Disease: A Comprehensive Review. Drug induced exfoliative dermatitis: state of the art - PubMed . 2008;23(5):54750. Exfoliative Dermatitis to Anti Tubercular Drugs - Academia.edu Drug induced exfoliative dermatitis: state of the art. - Abstract Bethesda, MD 20894, Web Policies and transmitted securely. Tohyama M, Hashimoto K. Immunological mechanisms of epidermal damage in toxic epidermal necrolysis. Soak for 5 to 10 minutes and rinse off before patting dry. 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. A marked increase in serum soluble Fas ligand in drug-induced hypersensitivity syndrome. 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. Ko TM, et al. Palynziq PEGVALIASE 20 mg/mL BioMarin Pharmaceutical Inc. Federal government websites often end in .gov or .mil. Autologous transplantation of mesenchymal umbilical cord cells seems also to be highly efficacious [102]. Wolkenstein P, et al. Br J Dermatol. Sekula P, et al. Umbilical cord mesenchymal stem cell transplantation in drug-induced StevensJohnson syndrome. ADRJ,2015,17(6):464-465. 2005;102(11):41349. Diclofenac sodium topical solution, like other NSAIDs, can cause serious systemic skin side effects such as exfoliative dermatitis, SJS, and TEN, which may result in hospitalizations . Roujeau JC, et al. Schopf E, et al. Accessibility If there is a high suspicion of infection without a documented source of infection, broad range empiric therapy should be started. Some anti-seizure medicines have also been known to cause exfoliative dermatitis. Patients can be extremely suffering because of the pain induced by skin and mucosal detachment. In an open trial on cyclosporine in 29 patients with TEN, the use of Cys A for at least 10days led to a rapid improvement without infective complications [112]. Nassif A, et al. Recently, a meta-analysis based on 6 retrospective studies evaluating the role of corticosteroids alone or together with IVIG has been published [107]. The erythrodermic form of mycosis fungoides and the Szary syndrome may also be difficult to distinguish from benign erythroderma. Insidious development of the erythroderma, progressive debilitation of the patient, absence of previous skin disease and resistance to standard therapy are features that may suggest an underlying malignancy.6,11, Erythroderma is also associated with disorders that cannot easily be classified into groups. Terms and Conditions, Harr T, French LE. The most notable member of this group is mycosis fungoides. New York: McGraw-Hill; 2003. p. 585600. N Engl J Med. Case Rep Dermatol. 2012;66(6):9951003. Moreover, after granulysin depletion, they observed an increase in cell viability. Drug induced exfoliative dermatitis - yxw_88 - | Incidence of hypersensitivity skin reactions. Medical search. Frequent Pathophysiology DIP. 1991;127(6):83942. 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. 2011;66(3):3607. T and NK lymphocytes can produce FasL that eventually binds to target cells. 1995;14(6):5589. A marker for StevensJohnson syndrome: ethnicity matters. 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. Google Scholar. A central role in the pathogenesis of ED is played by CD8+ lymphocytes and NK cells. 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. 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. On the other hand, it has been demonstrated that genetic predisposition may increase the risk for sulphonamide-induced [24] and carbamazepine-induced TEN and SJS [25]. CAS (PDF) DiHS/DRESS syndrome induced by second-line treatment for Arch Dermatol. asiatic) before starting therapies with possible triggers (e.g. Overall, T cells are the central player of these immune-mediated drug reactions. Toxic epidermal necrolysis and StevensJohnson syndrome. Etanercept therapy for toxic epidermal necrolysis. It is recommended to use 1.5mg/kg hydrocortisone. PDF Drug induced exfoliative dermatitis: state of the art Clin Pharmacol Ther. Int J Mol Sci. 2010;88(1):608. The https:// ensures that you are connecting to the Barbaud A. The incidence of erythema multiforme, StevensJohnson syndrome, and toxic epidermal necrolysis. This site needs JavaScript to work properly. J Am Acad Dermatol. 2014;71(5):9417. The epidermal-dermal junction shows changes, ranging from vacuolar alteration to subepidermal blisters [20]. Chapter 23. Exfoliative Dermatitis | Fitzpatrick's Dermatology in An increased metabolism is typical of patients with extended disepithelizated areas. 2014;81(1):1521. The relative risk of leukemia inducing erythroderma is highly variable, ranging from 11 to 50 percent.11, Internal (visceral) malignancies cause about 1 percent of all cases of exfoliative dermatitis.11 Frequently, erythroderma is the presenting sign of the malignancy. California Privacy Statement, The most important actions to do are listed in Fig. Drug eruptions that initially present as morbilliform, lichenoid or urticarial rashes may progress to generalized exfoliative dermatitis. Anti-tubercular therapy (ATT) induced exfoliative dermatitis-A case Strom BL, et al. Dr. Ramesh Bhandari - Deputy Co-ordinator & Secretary, AMC - LinkedIn Most common used drugs are: morphine, fentanyl, propofol and midazolam. When it precedes cutaneous T-cell lymphoma lesions, exfoliative dermatitis becomes the presenting sign of the underlying malignancy. Narita YM, et al. Recurrent erythema multiforme in association with recurrent Mycoplasma pneumoniae infections. Drug induced exfoliative dermatitis: state of the art. 2012;12(4):37682. [Erythema multiforme vs. Stevens-Johnson syndrome and toxic epidermal necrolysis: an important diagnostic distinction]. It is also recommended to void larger vesicles with a syringe. Exfoliative Dermatitis | AAFP
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