New insights into the diagnosis and management of patients with cutaneous drug hypersensitivity.

Abstract

Purpose of review: Cutaneous drug hypersensitivity reactions (CDHRs) are immune-mediated adverse events with significant morbidity and mortality. Their diverse clinical presentations, complex pathophysiology, and growing list of causative agents pose considerable diagnostic and therapeutic challenges. This review summarizes recent advances aimed at improving the identification and management of CDHRs.

Recent findings: A multi-dimensional diagnostic approach is now recommended, integrating detailed clinical phenotyping, validated causality assessment scales, and objective testing - including skin tests, in-vitro assays (e.g. LTT, ELISpot), and pharmacogenomic screening for high-risk HLA alleles. Innovations in test methodology have enhanced diagnostic accuracy. Concurrently, insights into immune mechanisms have driven the development of targeted therapies, such as TNF-α inhibitors, JAK inhibitors, and interleukin antagonists, offering new options for severe or refractory cases.

Summary: The integration of optimized diagnostic tools enables more precise identification of culprit drugs. Furthermore, the advent of mechanism-based biologics and small-molecule agents, alongside proactive HLA screening, is shifting the management paradigm from reactive treatment toward precision medicine and primary prevention. These advances collectively aim to reduce the burden of CDHRs, improve patient outcomes, and guide safer prescribing practices.