Drug reactions

5  Non-tumorous skin diseases

5.20  Drug reactions

5.20.1  Lichenoid drug eruptions


Some drug reactions can have lichenoid appearance

5.20.2  Eczematoid drug reaction


Drug reaction with histological signs of eczema dermatitis.

5.20.3  Drug reaction, multiform type


Drug reaction, histologicaly resembling erythema multiforme (necrotic keratinocytes, variable lymphocytic infiltrate, edema of the papillary corium and sometimes even subepidermal vesicle.


Drug reaction, multiform type, dyskeratoses:
Drug reaction, HE 40x (12863)

Drug reaction, multiform type, dyskeratoses, ev. inicial erythema multiforme:
Drug reaction, HE 40x (12864)

5.20.4  Fixed drug reaction

Clinical signs:

  • one, sometimes more maculae
  • location: skin of the genital, extremities, trunk, mouth
  • macular lesion, rarely bullous
  • color red, purple, red-brown (melanophages in recurrent lesions)
  • recurrences usually at the same location


Vacuolar alteration of the basal layer, pigment incontinence, dyskeratoses, slight (variable) parakeratosis, fibrosis of the papillary dermis.


Fixex drug reaction:
Fixed drug reaction, HE 60x (10168)

5.20.5  Toxoallergic reaction

Clinical signs:

  • generalised toxoallergic exanthemas are symmetrical
  • location: inner aspects of the extremities, lateral sides of the trunk
  • maculopapulous exanthema, urticarial or multiform
  • color: pink, red, purple


Generalized toxoallergic reaction to iodine:
Toxoalergic exanthema, CLINIC (733)

Toxoallergic exanthema after Diacordin:
Toxoalergic exanthema, CLINIC (734)

Toxoallergic exanthema:
Toxoalergic exanthema, CLINIC (735)

Toxoallergic exanthema (Glyvenol):
Toxoalergic exanthema, CLINIC (1052)

Exanthema toxoalergicum :
Toxoalergic exanthema, CLINIC (1053)

Exanthema toxoalergicum:
Toxoalergic exanthema, CLINIC (1054)

Allergic exanthema caused by atenolol:
Allergic exanthema caused by atenolol, CLINIC (5963)

Allergic exanthema caused by erythromycin:
Allergic exanthema caused by erythromycin, CLINIC (5964)

Allergic exanthema caused by paralen or penicillin, compared with normal skin:
Allergic exanthema caused by paralen or penicillin, CLINIC (5965)

Allergic exanthema caused by paralen or penicillin, comp. with normal skin, CLINIC (5966)

Toxoallergic exanthema, old warfarinized woman:
Toxoallergic exanthema, warfarinized woman, CLINIC (5978)

Toxoallergic exanthema, warfarinized woman, CLINIC (5979)

5.20.6  Vesicular drug reaction


Drug reaction in acute form may form vesicles or bullae (often subepidermal).

5.20.7  Pustular drug reaction


Pustular drug reaction closely resembles active psoriasis.

5.20.8  Folliculitis caused by EGFR inhibitors therapy


EGFR (epidermal growth factor receptor) is a cell surface receptor, whose mutations (overexpression) are associated with cancerogenesis. EGFR inhibitors are used in therapy of various tumors, namely carcinomas of the lung and colon. Testing for EGFR overexpression is important to estimate the outcome of EGFR inhibitors therapy.


Purulent folliculitis is an obligatory side effect of the therapy (present in more than two thirds of patients) and may be a marker for tumor response.


Perifollicular T lymphocytic infiltrate, neutrophilic infiltrate, sterile, especially at infundibular area. No comedones are formed, sebaceous glands are spared.

5.20.9  Antagonists of TNF-α therapy


Inhibitors of tumor nenecrotizing factor alpha have antiinflammatory influence (Infliximab, Adalimumab). There are many side effects of the therapy: erythema, leukocytoclastic vasculitis, local reactions, eczematoid urticarial, granulomatous and psoriatiform reactions, generalized infections  —  mycotic, viral and mycobacterial.

5.20.10  Terapie inhibitory tyrosinkin√°zy


Bcr-Abl tyrosinkinase inhibitors are used in chronic myeloic leukemia therapy.


Nilotinib, Bcr-Abl tyrosinkinase inhibitor, chronic myeloic leukemia therapy:
Reaction to nilotinib therapy, HE 40x (10244)

Tasigna (nilotinib), Bcr-Abl tyrosinkinase inhibitor, chronic myeloic leukemia therapy:
Folliculitis, Tasigna therapy, HE 60x (10800)

Nilotinib, Bcr-Abl tyrosinkinase inhibitor, myeloic leukemia therapy:
Nilotinib therapy, HE 40x (10590)

Nilotinib therapy, HE 40x (10591)

Nilotinib therapy, HE 40x (10592)

Nilotinib therapy, HE 40x (10593)

Nilotinib therapy, Giemsa 40x (10594)

5.20.11  Necrotising drug reaction


Some drug reactions with fulminant course are accompanied with widespread epidermal necroses (see toxic necrolysis of Lyell or erythema multiforme).


Widespread drug reaction:
Widespread drug reaction, CLINIC (1964)

5.20.12  Other drug reactions


Drug reactions have often unspecific histological appearance. Clinical information is necessary to make the diagnosis.


Dermal infiltrate with variable admixture of eosinophils.

5.20.13  Coumarin necrosis, coumarin caused bleeding


After administration of anticoagulative drugs with coumarine content skin necroses may develop. Coumarin therapy (warfarin) can cause dermal bleeding.

5.20.14  Striae after prolonged therapy by corticosteroids


Striae after prolonged therapy by corticosteroids:
Striae after long lasting application of corticosteroids, CLINIC (3352)


Further examples of drug reactions (clinical pictures):


Epidermis is thinned, dermal elastic fibres are fragmented.


Striae distensae, GVHD treated with corticosteroids:
Striae distensae, HE 20x (4360)

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