Casagranda Aneline, Suppa Mariano, Dehavay Florence, Del Marmol Véronique
Department of Dermatology and Venereology, Erasme Hospital, ULB, Brussels, Belgium.
Case Rep Dermatol. 2017 May 8;9(2):1-7. doi: 10.1159/000475802. eCollection 2017 May-Aug.
Drug-induced severe cutaneous adverse reactions (SCARs) include acute generalized exanthematous pustulosis, drug reaction with eosinophilia and systemic symptoms (DRESS), and epidermal necrolysis (Stevens-Johnson syndrome [SJS], toxic epidermal necrolysis). The identification of the causal drug is crucial in order to avoid further exposure, but making the right differential diagnosis of the type of SCAR is equally important since treatment, follow-up, and prognosis of different SCARs are not the same. These syndromes are distinct entities with different clinical, biological, and histological patterns, but sometimes the early distinction between 2 SCARs can be extremely challenging, and overlapping conditions could therefore be taken into consideration, although true overlapping SCARs are very rare when using strict diagnostic criteria (described by the RegiSCAR group). Only a better understanding of the physiopathology of the SCARs could possibly explain these ambiguities and overlaps. We report a case of SCAR in an 86-year-old patient probably induced by allopurinol and simultaneously fulfilling the diagnostic criteria for DRESS and SJS, thus considered as an overlapping case of SCARs.
药物性严重皮肤不良反应（SCARs）包括急性泛发性脓疱性银屑病、伴有嗜酸性粒细胞增多和全身症状的药物反应（DRESS）以及表皮坏死松解症（史蒂文斯-约翰逊综合征[SJS]、中毒性表皮坏死松解症）。明确致病药物对于避免再次接触至关重要，但对SCAR类型做出正确的鉴别诊断同样重要，因为不同SCAR的治疗、随访及预后各不相同。这些综合征是具有不同临床、生物学和组织学表现的不同实体，但有时早期区分两种SCAR极具挑战性，因此可能需要考虑重叠情况，不过使用严格诊断标准（由RegiSCAR小组描述）时，真正重叠的SCAR非常罕见。只有更好地理解SCAR的生理病理学，才有可能解释这些模糊性和重叠情况。我们报告一例86岁患者的SCAR病例，可能由别嘌醇诱发，同时符合DRESS和SJS的诊断标准，因此被视为SCAR的重叠病例。
