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The Thai Journal of Pharmaceutical Sciences

Abstract

Severe cutaneous adverse reactions (SCARs) are life-threatening drug hypersensitivity reactions, including acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens–Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). SCARs occur in approximately 0.1% of hospitalizations and have mortality rates ranging from 5% for AGEP to 5–35% for SJS/TEN. AGEP typically presents with acute erythematous areas, sterile pustules, fever, and neutrophilia within 48–72 h of drug exposure. In contrast, DRESS manifests as fever, facial edema, morbilliform rash, and exfoliative dermatitis, often accompanied by hematologic abnormalities and multi-organ involvement, including hepatitis, pneumonitis, and myocarditis. Moreover, SJS and TEN are severe mucocutaneous reactions characterized by erythematous macules, flaccid blisters, skin detachment, and mucosal involvement in over 80% of cases. They differ significantly in etiology, pathophysiology, and treatment strategies, but sometimes these conditions may share some clinical presentations or overlapping that are defined as the definite or probable diagnosis of at least 2 ADRs according to scoring systems for AGEP, DRESS, and SJS-TEN. Although overlapping SCARs diagnosis may be difficult and very rare, accurate identification and prompt intervention are critical for improving patient outcomes. This study aimed to describe clinical manifestation, pathogenesis, and immunohistopathology implications that may lead to better distinguish and more effective management.

DOI

10.56808/3027-7922.3066

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