Cutaneous drug reactions: classification, diagnosis, clinical and therapeutic consequences

Abstract

Background

Cutaneous adverse drug reactions cover a broad clinical and immunological spectrum—from common, mild maculopapular drug exanthema to potentially lethal forms such as Stevens–Johnson syndrome, toxic epidermal necrolysis, or drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. Due to the increasing life expectancy, rising multimorbidity, and growing polypharmacy, there is an increase not only in incidence, but also in diagnostic and therapeutic complexity. Cutaneous adverse drug reactions (CADRs) are highly relevant from a clinical and health economic perspective and require differentiated, guideline-based management.

Objective

The aim of this study is to provide a comprehensive overview of the pathophysiological mechanisms, clinical manifestations, and current diagnostic and therapeutic strategies for cutaneous drug reactions.

Results

Analyses of the current literature show that early and differentiated diagnosis is essential for the effective treatment of cutaneous drug reactions. Immunologically, CADRs can be classified predominantly as type IV hypersensitivity reactions. In addition to T‑cell-mediated mechanisms, genetic risk factors and viral reactivations are becoming increasingly important. Advances in biomarker research could further improve early and accurate diagnosis. Depending on the severity, topical or systemic corticosteroids, immunoglobulins, immunomodulatory agents such as ciclosporin or Janus kinase inhibitors are available for treatment.

Conclusion

Differentiating between cutaneous drug reactions based on their clinical presentation and underlying immunological mechanisms is crucial for choosing an appropriate therapy. Given the increasing prevalence and growing complexity of cutaneous drug reactions, a thorough understanding of pathophysiological relationships is essential. Current research approaches, in particular pharmacogenetic screening and validated biomarkers, offer promising opportunities to individualize diagnosis and therapy, thereby significantly expanding the range of treatment options in the future.