[Drug patch tests in the investigation of cutaneous adverse drug reactions]. 2009

A Barbaud
Service de dermatologie, hôpital Fournier, CHU de Nancy, 36, quai de la Bataille, 54000 Nancy, France. a.barbaud@chu-nancy.fr

Cutaneous adverse drug reactions (CADR) are a frequent problem in clinical medicine. Since patients are often on multiple drug regimes, it is often difficult to pinpoint the relevant drug from history alone. Besides clinical and chronological parameters, patch testing with the suspected compound has been reported as helpful in determining the cause of a CADR and in studying the physiopathological mechanisms involved in such reactions. The key advantage of drug patch tests is that they can be performed using any commercialized form of drugs and without hospital surveillance because they only rarely induce adverse reactions, which in any event are mild. The method for performing drug patch tests has been described, and requisite commercialized material is now commercially available, failing which the best approach is to dilute the drug in its commercialized form at 30% in petrolatum or in water. The results of drug patch tests depend on the drug tested and the clinical features of the initial CADR. They appear to be of value in investigating maculopapular rash, eczema at drug injection sites, photosensitivity (photopatch tests with 5J of irradiation), fixed drug eruption (testing at the sequelae site), acute generalized exanthematous pustulosis and symmetrical drug-related intertriginous flexural exanthema. Although less widely used, they are probably also of value in drug reaction with eosinophilia and systemic symptoms (DRESS) but they are of less use in Stevens-Johnson syndrome (SSJ) and Lyell's syndrome. Many drugs have been reported as producing positive patch tests, and most of these are summarized in a summary table of this literature review.

UI MeSH Term Description Entries
D010328 Patch Tests Skin tests in which the sensitizer is applied to a patch of cotton cloth or gauze held in place for approximately 48-72 hours. It is used for the elicitation of a contact hypersensitivity reaction. Patch Testing,Patch Test,Patch Testings,Test, Patch,Testing, Patch,Testings, Patch,Tests, Patch
D003875 Drug Eruptions Adverse cutaneous reactions caused by ingestion, parenteral use, or local application of a drug. These may assume various morphologic patterns and produce various types of lesions. Dermatitis Medicamentosa,Dermatitis, Adverse Drug Reaction,Maculopapular Drug Eruption,Maculopapular Exanthem,Morbilliform Drug Reaction,Morbilliform Exanthem,Drug Eruption,Drug Eruption, Maculopapular,Drug Eruptions, Maculopapular,Drug Reaction, Morbilliform,Drug Reactions, Morbilliform,Eruption, Drug,Eruption, Maculopapular Drug,Eruptions, Drug,Eruptions, Maculopapular Drug,Exanthem, Maculopapular,Exanthem, Morbilliform,Exanthems, Maculopapular,Exanthems, Morbilliform,Maculopapular Drug Eruptions,Maculopapular Exanthems,Morbilliform Drug Reactions,Morbilliform Exanthems,Reaction, Morbilliform Drug,Reactions, Morbilliform Drug
D004364 Pharmaceutical Preparations Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. Drug,Drugs,Pharmaceutical,Pharmaceutical Preparation,Pharmaceutical Product,Pharmaceutic Preparations,Pharmaceutical Products,Pharmaceuticals,Preparations, Pharmaceutical,Preparation, Pharmaceutical,Preparations, Pharmaceutic,Product, Pharmaceutical,Products, Pharmaceutical
D004802 Eosinophilia Abnormal increase of EOSINOPHILS in the blood, tissues or organs. Eosinophilia, Tropical,Hypereosinophilia,Tropical Eosinophilia,Hypereosinophilias,Tropical Eosinophilias
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013262 Stevens-Johnson Syndrome Rare cutaneous eruption characterized by extensive KERATINOCYTE apoptosis resulting in skin detachment with mucosal involvement. It is often provoked by the use of drugs (e.g., antibiotics and anticonvulsants) or associated with PNEUMONIA, MYCOPLASMA. It is considered a continuum of Toxic Epidermal Necrolysis. Drug-Induced Stevens Johnson Syndrome,Drug-Induced Stevens-Johnson Syndrome,Epidermal Necrolysis, Toxic,Lyell's Syndrome,Mycoplasma-Induced Stevens Johnson Syndrome,Mycoplasma-Induced Stevens-Johnson Syndrome,Nonstaphylococcal Scalded Skin Syndrome,Scalded Skin Syndrome, Nonstaphylococcal,Stevens Johnson Syndrome Toxic Epidermal Necrolysis,Stevens Johnson Syndrome Toxic Epidermal Necrolysis Spectrum,Stevens-Johnson Syndrome Toxic Epidermal Necrolysis,Stevens-Johnson Syndrome Toxic Epidermal Necrolysis Spectrum,Toxic Epidermal Necrolysis,Toxic Epidermal Necrolysis Stevens Johnson Syndrome,Toxic Epidermal Necrolysis Stevens Johnson Syndrome Spectrum,Toxic Epidermal Necrolysis Stevens-Johnson Syndrome,Toxic Epidermal Necrolysis Stevens-Johnson Syndrome Spectrum,Drug Induced Stevens Johnson Syndrome,Drug-Induced Stevens-Johnson Syndromes,Epidermal Necrolyses, Toxic,Lyell Syndrome,Lyell's Syndromes,Mycoplasma Induced Stevens Johnson Syndrome,Necrolyses, Toxic Epidermal,Necrolysis, Toxic Epidermal,Stevens Johnson Syndrome,Stevens-Johnson Syndrome, Drug-Induced,Stevens-Johnson Syndrome, Mycoplasma-Induced,Stevens-Johnson Syndromes, Drug-Induced,Syndrome, Lyell's,Syndrome, Mycoplasma-Induced Stevens-Johnson,Syndromes, Lyell's,Toxic Epidermal Necrolyses
D064420 Drug-Related Side Effects and Adverse Reactions Disorders that result from the intended use of PHARMACEUTICAL PREPARATIONS. Included in this heading are a broad variety of chemically-induced adverse conditions due to toxicity, DRUG INTERACTIONS, and metabolic effects of pharmaceuticals. Drug-Related Side Effects and Adverse Reaction,Adverse Drug Event,Adverse Drug Reaction,Drug Side Effects,Drug Toxicity,Side Effects of Drugs,Toxicity, Drug,Adverse Drug Events,Adverse Drug Reactions,Drug Event, Adverse,Drug Events, Adverse,Drug Reaction, Adverse,Drug Reactions, Adverse,Drug Related Side Effects and Adverse Reaction,Drug Related Side Effects and Adverse Reactions,Drug Side Effect,Drug Toxicities,Effects, Drug Side,Reactions, Adverse Drug,Side Effect, Drug,Side Effects, Drug,Toxicities, Drug
D064907 Diagnostic Uses of Chemicals Chemicals administered to patients in order to diagnose or study the pathology of medical conditions, diseases, or syndromes.

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