Harvard Medical School, Boston, MA, USA.
Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA.
Am J Clin Dermatol. 2021 May;22(3):349-366. doi: 10.1007/s40257-021-00586-8. Epub 2021 Feb 15.
Eczematous drug eruptions are a heterogenous group of skin reactions that resemble eczema both clinically and histologically. We reviewed the literature and cataloged the systemically administered medications that cause these eruptions, along with their characteristic clinical presentations. We identified three primary pathophysiologic etiologies: (1) cutaneous immunomodulation, (2) skin dehydration, and (3) delayed hypersensitivity. Notably, eczematous eruptions caused by altered immunity in the skin may be increasing in incidence as some responsible drugs, in particular biologic therapies (such as tumor necrosis factor-α and interleukin-17 inhibitors) and targeted cancer treatments (including immune checkpoint inhibitors and epidermal growth factor receptor inhibitors), become more commonly employed in clinical practice. Other notable causes of eczematous eruptions include antiviral agents for hepatitis C virus and cardiovascular medications in elderly individuals, and notable subtypes of eczematous reactions include systemic contact dermatitis and photoallergic reactions, which are also discussed. The diagnostic gold standard is drug rechallenge and most reactions may be treated effectively with emollients, topical corticosteroids, and oral antihistamines.
湿疹样药物反应是一组具有临床和组织学相似性的异质性皮肤反应。我们复习了文献，并对引起这些反应的全身性给药药物及其特征性临床表现进行了分类。我们确定了三种主要的病理生理病因：（1）皮肤免疫调节，（2）皮肤脱水，和（3）迟发性超敏反应。值得注意的是，由于某些负责药物（特别是生物疗法（如肿瘤坏死因子-α和白细胞介素-17 抑制剂）和靶向癌症治疗（包括免疫检查点抑制剂和表皮生长因子受体抑制剂））在临床实践中越来越常用，因此皮肤免疫改变引起的湿疹样反应的发生率可能在增加。其他值得注意的湿疹样反应包括丙型肝炎病毒的抗病毒药物和老年人的心血管药物，湿疹样反应的显著亚型包括全身性接触性皮炎和光过敏反应，这些也在讨论中。诊断的金标准是药物再激发，大多数反应可以通过保湿剂、局部皮质类固醇和口服抗组胺药有效治疗。
