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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...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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MDPI
2022
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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 |
author_sort | Khandpur, Sujay |
collection | PubMed |
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. |
format | Online Article Text |
id | pubmed-9149972 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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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