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Comparative histological analysis of drug‐induced maculopapular exanthema and DRESS
Author(s) -
Skowron F.,
Bensaid B.,
Balme B.,
Depaepe L.,
Kanitakis J.,
Nosbaum A.,
MaucortBoulch D.,
Bérard F.,
D'Incan M.,
Kardaun S.H.,
Nicolas J.F.
Publication year - 2016
Publication title -
journal of the european academy of dermatology and venereology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.655
H-Index - 107
eISSN - 1468-3083
pISSN - 0926-9959
DOI - 10.1111/jdv.13832
Subject(s) - medicine , spongiosis , histopathology , dermatology , leukocytoclastic vasculitis , maculopapular rash , pathology , drug reaction , adverse drug reaction , vasculitis , drug eruption , drug , rash , disease , psychiatry
Background Cutaneous adverse drug reactions frequently present as a benign maculopapular exanthema ( MPE ) with a rapid healing. Sometimes systemic signs are present, which could represent a more severe or systemic MPE ( sMPE ) or even be the initial phase of a drug reaction with eosinophilia and systemic symptoms ( DRESS ). Histopathology associated with MPE , sMPE and DRESS has not been well characterized. Objectives To study the cutaneous histopathological changes associated with MPE , sMPE and DRESS . Methods A retrospective clinicopathological analysis of 13 cases of MPE , 13 of sMPE and 45 of DRESS , collected in one centre from 2005 to 2013. Results The number of histopathological changes per section increased gradually from MPE to sMPE and DRESS . Prevalence of spongiosis, dermal lymphocytes, eosinophils and neutrophils did not differ between MPE , sMPE and DRESS . Keratinocyte damage, rare in MPE , was regularly found in sMPE and frequent in DRESS . The density of the inflammatory infiltrate increased progressively from MPE to sMPE and DRESS . Atypical lymphocytes were absent in MPE , present in sMPE and more frequent in DRESS . Deep dermal involvement and leukocytoclastic vasculitis were only observed in DRESS. Limitations This was a retrospective study. Conclusions Numerous histopathological changes per section in drug‐induced exanthema should alert for a more severe form of cutaneous adverse drug reactions, i.e. DRESS .