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Drug-Induced vs. Viral Maculopapular Exanthem—Resolving the Dilemma

Maculopapular exanthem is a commonly encountered presentation in routine clinical practice, and differentiation between its two most common etiologies, i.e., viral- and drug-induced, often poses a diagnostic dilemma. Clinical, hematological and biochemical investigations are seldom reliable in disti...

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Detalles Bibliográficos
Autores principales: Khandpur, Sujay, Ahuja, Rhea
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9149972/
https://www.ncbi.nlm.nih.gov/pubmed/35645232
http://dx.doi.org/10.3390/dermatopathology9020021
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author Khandpur, Sujay
Ahuja, Rhea
author_facet Khandpur, Sujay
Ahuja, Rhea
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description Maculopapular exanthem is a commonly encountered presentation in routine clinical practice, and differentiation between its two most common etiologies, i.e., viral- and drug-induced, often poses a diagnostic dilemma. Clinical, hematological and biochemical investigations are seldom reliable in distinguishing between a drug reaction and a viral exanthem. Certain key histopathological features such as the presence of a moderate degree of spongiosis, extensive basal cell damage with multiple necrotic keratinocytes and dermal infiltrate rich in eosinophils or lymphocytes and histiocytes may favor a drug exanthem, while distinctive epidermal cytopathic changes and lymphocytic vasculitis point towards a viral etiology. Similarly, notable immunohistochemical markers such as IL-5, eotaxin and FAS ligand may support a diagnosis of a drug-induced maculopapular eruption. Histopathological and immunohistochemical evaluations may help in distinguishing between the two etiologies when faced with a clinical overlap, especially in patients on multiple essential drugs when drug withdrawal and rechallenge is not feasible.
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spelling pubmed-91499722022-05-31 Drug-Induced vs. Viral Maculopapular Exanthem—Resolving the Dilemma Khandpur, Sujay Ahuja, Rhea Dermatopathology (Basel) Review Maculopapular exanthem is a commonly encountered presentation in routine clinical practice, and differentiation between its two most common etiologies, i.e., viral- and drug-induced, often poses a diagnostic dilemma. Clinical, hematological and biochemical investigations are seldom reliable in distinguishing between a drug reaction and a viral exanthem. Certain key histopathological features such as the presence of a moderate degree of spongiosis, extensive basal cell damage with multiple necrotic keratinocytes and dermal infiltrate rich in eosinophils or lymphocytes and histiocytes may favor a drug exanthem, while distinctive epidermal cytopathic changes and lymphocytic vasculitis point towards a viral etiology. Similarly, notable immunohistochemical markers such as IL-5, eotaxin and FAS ligand may support a diagnosis of a drug-induced maculopapular eruption. Histopathological and immunohistochemical evaluations may help in distinguishing between the two etiologies when faced with a clinical overlap, especially in patients on multiple essential drugs when drug withdrawal and rechallenge is not feasible. MDPI 2022-05-07 /pmc/articles/PMC9149972/ /pubmed/35645232 http://dx.doi.org/10.3390/dermatopathology9020021 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Khandpur, Sujay
Ahuja, Rhea
Drug-Induced vs. Viral Maculopapular Exanthem—Resolving the Dilemma
title Drug-Induced vs. Viral Maculopapular Exanthem—Resolving the Dilemma
title_full Drug-Induced vs. Viral Maculopapular Exanthem—Resolving the Dilemma
title_fullStr Drug-Induced vs. Viral Maculopapular Exanthem—Resolving the Dilemma
title_full_unstemmed Drug-Induced vs. Viral Maculopapular Exanthem—Resolving the Dilemma
title_short Drug-Induced vs. Viral Maculopapular Exanthem—Resolving the Dilemma
title_sort drug-induced vs. viral maculopapular exanthem—resolving the dilemma
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9149972/
https://www.ncbi.nlm.nih.gov/pubmed/35645232
http://dx.doi.org/10.3390/dermatopathology9020021
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