Recognizing Drug Hypersensitivity in Pigmented Skin

Rannakoe J Lehloenya; Elizabeth J Phillips; Helena B Pasieka; Jonny Peter

doi:10.1016/j.iac.2022.01.005

Recognizing Drug Hypersensitivity in Pigmented Skin

Immunol Allergy Clin North Am. 2022 May;42(2):219-238. doi: 10.1016/j.iac.2022.01.005. Epub 2022 Mar 31.

Authors

Rannakoe J Lehloenya¹, Elizabeth J Phillips², Helena B Pasieka³, Jonny Peter⁴

Affiliations

¹ Division of Dermatology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Dermatology ward G23, New Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa; Combined Drug Allergy Clinic, Groote Schuur Hospital, Dermatology ward G23, New Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa. Electronic address: rannakoe.lehloenya@uct.ac.za.
² Center for Drug Safety & Immunology, Vanderbilt University Medical Center, Nashville, TN; Institute for Immunology & Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia.
³ Department of Dermatology, Uniformed Serviced University, Bethesda, MD, USA; Department of Medicine, Uniformed Serviced University, Bethesda, MD, USA; Department of Dermatology, MedStar Washington Hospital Center/Georgetown University Hospital, Washington, DC, USA; The Burn Center, MedStar Washington Hospital Center, Washington, DC, USA.
⁴ Combined Drug Allergy Clinic, Groote Schuur Hospital, Dermatology ward G23, New Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa; Division of Allergy and Clinical Immunology, Department of Medicine, Groote Schuur Hospital, University of Cape Town Lung institute, George Street, Mowbray, 7925, Cape Town, South Africa; Allergy and Immunology Unit, University of Cape Town Lung Institute, Old Main Building, Groote Schuur Hospital, Anzio Road, 7925, Cape Town, South Africa.

Abstract

The imagery of pigmented skin is underrepresented in teaching materials such as textbooks, journals, and online references, and this has resulted in poorer diagnostic and management outcomes of skin pathology, including delayed cutaneous drug hypersensitivity reactions. In this review, we use clinical images to highlight factors that impact clinical presentations and sequelae of drug hypersensitivity reactions in pigmented skin compared with nonpigmented skin. We describe clinical features in some anatomic sites that aid diagnosis or are associated with more severe sequelae. Finally, we discuss strategies that may aid the diagnosis and management of these reactions in pigmented skin.

Keywords: Clinical presentation; Drug hypersensitivity reactions; Pigmented skin; Sequelae.

Recognizing Drug Hypersensitivity in Pigmented Skin

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