TY  - CHAP
M1  - Book, Section
TI  - Cutaneous Drug Eruptions
A1  - Crowson, A. Neil
A1  - Magro, Cynthia M.
A2  - Barnhill, Raymond L.
A2  - Crowson, A. Neil
A2  - Magro, Cynthia M.
A2  - Piepkorn, Michael W.
A2  - Kutzner, Heinz
A2  - Desman, Garrett T.
PY  - 2020
T2  - Barnhill's Dermatopathology, 4e
AB  - In  consequence  of  polypharmacy  in  an  aging  population  and  the  continuous  stream  of  novel  drugs  being  brought  to  market  in  the  modern  era,  systemic  drug  reactions  are  increasing  in  frequency  and  complexity  and  are  thus  a  constant  challenge  to  clinicians  and  pathologists.1,2  Adverse  clinical  manifestations  resulting  from  administration  of  medicinal  agents  account  for  between  2  per  10003  and  2  per  100  of  hospital  admissions,4  affect  1%  to  2%  of  the  population,  and  are  said  to  generate  roughly  $3  billion  of  annual  expense  in  the  United  States.5  Although  many  organ  systems  may  be  involved,  cutaneous  manifestations  are  frequent  and  offer  a  window  for  diagnosis.  Drug  reactions  may  be  immunologic  or  nonimmunologic,  the  latter  consisting  of  overdosage,  intolerance,  teratogenicity,  facultative  effects  that  result  from  disruption  of  bacterial  flora  in  mucous  membranes  and  skin,  and  toxicity,  the  latter  either  delayed  (eg,  carcinogenic)  or  cumulative  (eg,  pigmentary  disturbances  due  to  deposition  of  gold  or  silver).  Other  nonimmunologic  mechanisms  of  drug  toxicity  include  anaphylactic  reactions  due  to  agents  that  degranulate  mast  cells  (eg,  opiates)  or  impair  arachidonic  acid  metabolism  (eg,  cyclooxygenase  inhibitors  such  as  acetylsalicylic  acid  or  other  nonsteroidal  anti-inflammatory  agents).  Recent  advances  in  our  understanding  of  perturbational  effects  of  drugs  on  the  immune  system  indicate  that  classes  of  drugs  that  alter  immune  function  may  dramatically  modify  the  cutaneous  response  to  exogenous  antigens,  including  drugs  of  alternate  classes.6  Cutaneous  drug  reactions  also  can  be  exacerbated  in  the  setting  of  immune  dysregulation  caused  by  infection  with  agents  such  as  human  immunodeficiency  virus  (HIV),7,8  cytomegalovirus  (CMV),9,10  and  human  herpesvirus  6  (HHV-6)  in  the  context  of  the  idiopathic  drug  hypersensitivity  syndrome  consisting  of  erythroderma,  facial  edema,  lymphadenopathy,  hepatopathy  with  circulating  atypical  lymphocytes,  and  a  rash  with  a  mycosis  fungoides  (MF)-like  histology.10-12  
SN  - 
PB  - McGraw Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - dermatology.mhmedical.com/content.aspx?aid=1178391783
ER  -