Kutanöz İlaç Reaksiyonları
Özet
Kutanöz ilaç reaksiyonları, sık görülen hafif döküntülerden yaşamı tehdit eden ağır kutanöz advers reaksiyonlara kadar geniş bir klinik spektrum oluşturur. Bu bölümde advers ilaç reaksiyonlarının temel sınıflaması ve immünolojik mekanizmaları özetlenmekte; makülopapüler ilaç erüpsiyonu, ürtiker ve anjiyoödem, anafilaksi, fiks ilaç erüpsiyonu, akut generalize ekzantematöz püstüloz (AGEP), eozinofili ve sistemik semptomlarla seyreden ilaç reaksiyonu (DRESS), Stevens–Johnson sendromu/toksik epidermal nekroliz (SJS/TEN), ilaç ilişkili vaskülit, eritrodermi ve simetrik ilaç ilişkili intertriginöz ve fleksural ekzantem (SDRIFE) gibi başlıca klinik tablolar ele alınmaktadır. Ayrıca ilaç ilişkili fotosensitivite, saç dökülmesi, antikanser tedavilere bağlı kutanöz reaksiyonlar ve antikoagülanlara bağlı deri nekrozu kısaca gözden geçirilmektedir. Her klinik tablo için olası tetikleyiciler, tipik bulgular, tanısal yaklaşım, ayırıcı tanı, tedavi ve prognoz vurgulanmaktadır. Bölümün son kısmında, birinci basamakta izlenebilecek hastalar ile dermatoloji değerlendirmesi veya acil sevk gerektiren olgular ayırt edilmekte ve alarm bulgularına dikkat çekilmektedir.
Referanslar
Del Pozzo‐Magaña BR, Liy‐Wong C. Drugs and the skin: A concise review of cutaneous adverse drug reactions. British Journal of Clinical Pharmacology. 2024;90(8):1838–1855. doi:10.1111/bcp.15490
Stern RS. Exanthematous Drug Eruptions. New England Journal of Medicine. 2012;366(26):2492–2501. doi:10.1056/NEJMcp1104080
Noe MH. Morbilliform Drug Eruption. In: Rosenbach M, Wanat K, Micheletti R, Taylor L (eds.) Inpatient Dermatology. Cham: Springer International Publishing; 2018. p. 13–16. doi:10.1007/978-3-319-18449-4_2
Cardona V, Ansotegui IJ, Ebisawa M, et al. World Allergy Organization Anaphylaxis Guidance 2020. World Allergy Organization Journal. 2020;13(10):100472. doi:10.1016/j.waojou.2020.100472
Patel S, John AM, Handler MZ, et al. Fixed Drug Eruptions: An Update, Emphasizing the Potentially Lethal Generalized Bullous Fixed Drug Eruption. American Journal of Clinical Dermatology. 2020;21(3):393–399. doi:10.1007/s40257-020-00505-3
Anderson HJ, Lee JB. A Review of Fixed Drug Eruption with a Special Focus on Generalized Bullous Fixed Drug Eruption. Medicina. 2021;57(9):925. doi:10.3390/medicina57090925
Parisi R, Shah H, Navarini AA, et al. Acute Generalized Exanthematous Pustulosis: Clinical Features, Differential Diagnosis, and Management. American Journal of Clinical Dermatology. 2023;24(4):557–575. doi:10.1007/s40257-023-00779-3
Tetart F, Walsh S, Milpied B, et al. Acute generalized exanthematous pustulosis: European expert consensus for diagnosis and management. Journal of the European Academy of Dermatology and Venereology. 2024;38(11):2073–2081. doi:10.1111/jdv.20232
Wolfson AR, Zhou L, Li Y, et al. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Identified in the Electronic Health Record Allergy Module. Journal of Allergy and Clinical Immunology: In Practice. 2019;7(2):633–640. doi:10.1016/j.jaip.2018.08.013
Kim GY, Anderson KR, Davis DMR, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS) in the pediatric population: A systematic review of the literature. Journal of the American Academy of Dermatology. 2020;83(5):1323–1330. doi:10.1016/j.jaad.2020.03.081
Husain Z, Reddy BY, Schwartz RA. DRESS syndrome. Journal of the American Academy of Dermatology. 2013;68(5):693.e1–693.e14. doi:10.1016/j.jaad.2013.01.033
Brüggen MC, Walsh S, Ameri MM, et al. Management of Adult Patients With Drug Reaction With Eosinophilia and Systemic Symptoms. JAMA Dermatology. 2024;160(1):37–44. doi:10.1001/jamadermatol.2023.4450
Tetart F, Picard D, Janela B, et al. Prolonged Evolution of Drug Reaction With Eosinophilia and Systemic Symptoms. JAMA Dermatology. 2014;150(2):206–207. doi:10.1001/jamadermatol.2013.6698
Santiago F, Gonçalo M, Vieira R, et al. Epicutaneous patch testing in drug hypersensitivity syndrome (DRESS). Contact Dermatitis. 2010;62(1):47–53. doi:10.1111/j.1600-0536.2009.01659.x
Mizukawa Y, Shiohara T. Recent advances in the diagnosis and treatment of DIHS/DRESS in 2025. Allergology International. 2025;74(3):372–379. doi:10.1016/j.alit.2025.03.007
Kridin K, Brüggen M, Walsh S, et al. Management and treatment outcome of DRESS patients in Europe: An international multicentre retrospective study of 141 cases. Journal of the European Academy of Dermatology and Venereology. 2023;37(4):753–762. doi:10.1111/jdv.18808
Shah H, Parisi R, Mukherjee E, et al. Update on Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: Diagnosis and Management. American Journal of Clinical Dermatology. 2024;25(6):891–908. doi:10.1007/s40257-024-00889-6
Hama N, Aoki S, Chen CB, et al. Recent progress in Stevens–Johnson syndrome/toxic epidermal necrolysis: diagnostic criteria, pathogenesis and treatment. British Journal of Dermatology. 2025;192(1):9–18. doi:10.1093/bjd/ljae321
Hsu DY, Brieva J, Silverberg NB, et al. Morbidity and Mortality of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in United States Adults. Journal of Investigative Dermatology. 2016;136(7):1387–1397. doi:10.1016/j.jid.2016.03.023
Pang Y, Nguyen WQ, Guerrero LI, et al. Deciphering the Etiologies of Adult Erythroderma: An Updated Guide to Presentations, Diagnostic Tools, Pathophysiologies, and Treatments. American Journal of Clinical Dermatology. 2024;25(6):927–950. doi:10.1007/s40257-024-00886-9
Winnicki M, Shear NH. A Systematic Approach to Systemic Contact Dermatitis and Symmetric Drug-Related Intertriginous and Flexural Exanthema (SDRIFE). American Journal of Clinical Dermatology. 2011;12(3):171–180. doi:10.2165/11539080-000000000-00000
Monteiro AF, Rato M, Martins C. Drug-induced photosensitivity: Photoallergic and phototoxic reactions. Clinics in Dermatology. 2016;34(5):571–581. doi:10.1016/j.clindermatol.2016.05.006
Young JWS, Shear NH. Cutaneous Drug Reactions in the Elderly. Drugs & Aging. 2017;34(9):655–672. doi:10.1007/s40266-017-0483-5
