Consilium MedicumConsilium Medicum2075-17532542-2170Consilium Medicum9710510.26442/20751753.2021.8.201180Review ArticleAcute conditions in dermatology: toxic reactions and their treatmentSakaniyaLuiza R.<p>dermatologist, </p>marykor@bk.ruhttps://orcid.org/0000-0003-2027-5987PlievaKristina T.<p>dermatologist</p>marykor@bk.ruhttps://orcid.org/0000-0001-9351-1034DenisovaElena V.<p>Cand. Sci. (Med.)</p>marykor@bk.ruhttps://orcid.org/0000-0002-4887-284XKorsunskayaIrina M.<p>D. Sci. (Med.), Prof.</p>marykor@bk.ruhttps://orcid.org/0000-0002-6583-0318Center for Theoretical Problems of Physicochemical PharmacologyMoscow Scientific and Practical Center of Dermatology, Venereology and Cosmetology150820212386686712101202221012022Copyright © 2021, Consilium Medicum2021<p>Acute severe conditions caused by the use of various drugs are of particular difficulty in dermatological practice. Toxicodermic reactions include DRESS syndrome, StevensJohnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis and erythroderma of various origins. These disorders are characterized not only by skin lesions, but also toxic reactions in internal organs, which if untreated properly can be life-threatening. The first choice drugs for such reactions are systemic glucocorticosteroids, in particular betamethasone derivatives. Our own experience and numerous studies confirm the effectiveness of such drugs. However, it should be remembered that uncontrolled or prolonged use of systemic glucocorticosteroids can aggravate the patient's condition and lead to unwanted adverse reactions.</p>toxidermiaerythrodermadrug reactionssystemic glucocorticosteroidsbetamethasoneтоксидермияэритродермиялекарственные реакциисистемные глюкокортикостероидыбетаметазон[Nayak S, Acharjya B. Adverse cutaneous drug reaction. Indian J Dermatol. 2008;53(1):2-8.][Executive summary of disease management of drug hypersensitivity: a practice parameter. Joint Task Force on Practice Parameters, the American Academy of Allergy, Asthma and Immunology, the American Academy of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol. 1999;83(6 Pt. 3):665-700.][DeShazo RD, Kemp SF. Allergic reactions to drugs and biologic agents. JAMA. 1997;278(22):1895-906.][Niebel D, Wenzel J. Immunopathology of cutaneous drug eruptions. Pathologe. 2018;39(6):563-70.][Graudins LV, Trubiano JA, Zubrinich CM, et al. Medication-related anaphylaxis treated in hospital: Agents implicated, patient outcomes, and management lessons. Pharmacoepidemiol Drug Saf. 2018;27(9):1029-33.][Formica D, Sultana J, Cutroneo PM, et al. The economic burden of preventable adverse drug reactions: a systematic review of observational studies. Expert Opin Drug Saf. 2018;17(7):681-95.][Aung AK, Tang MJ, Adler NR, et al. Adverse Drug Reactions Reported by Healthcare Professionals: Reaction Characteristics and Time to Reporting. J Clin Pharmacol. 2018;58(10):1332-9.][Allegaert K, Smits A, van den Anker JN. Drug evaluation studies in neonates: how to overcome the current limitations. Expert Rev Clin Pharmacol. 2018;11(4):387-96.][Van Schandevyl G, Bauters T. Thiotepa-induced cutaneous toxicity in pediatric patients: Case report and implementation of preventive care guidelines. J Oncol Pharm Pract. 2019;25(3):689-93.][Amsler E, Soria A. Hypersensitivity reactions to beta-lactam antibiotics. Rev Med Interne. 2017;38(11):737-48.][Okoduwa C, Lambert WC, Schwartz RA, et al. Erythroderma: review of a potentially life-threatening dermatosis. Indian J Dermatol. 2009;54(1):1-6. DOI:10.4103/0019-5154.48976][Akhyani M, Ghodsi ZS, Toosi S, Dabbaghian H. Erythroderma: a clinical study of 97 cases. BMC Dermatol. 2005;5:5. DOI:10.1186/1471-5945-5-5][César A, Cruz M, Mota A, Azevedo F. Erythroderma. A clinical and etiological study of 103 patients. J Dermatol Case Rep. 2016;10(1):1-9. DOI:10.3315/jdcr.2016.1222][Rice AS, Crane JS. Epidermolytic Hyperkeratosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2021.][Tan GF, Kong YL, Tan AS, Tey HL. Causes and features of erythroderma. Ann Acad Med Singap. 2014;43(8):391-4.][Banerjee S, Ghosh S, Mandal RK. A Study of Correlation Between Clinical and Histopathological Findings of Erythroderma in North Bengal Population. Indian J Dermatol. 2015;60(6):549-55. DOI:10.4103/0019-5154.169124][Sehgal VN, Srivastava G. Exfoliative dermatitis. A prospective study of 80 patients. Dermatologica. 1986;173(6):278-84.][Mistry N, Gupta A, Alavi A, Sibbald RG. A review of the diagnosis and management of erythroderma (generalized red skin). Adv Skin Wound Care. 2015;28(5):228-36; quiz 237-8. DOI:10.1097/01.ASW.0000463573.40637.73][Karakayli G, Beckham G, Orengo I, Rosen T. Exfoliative dermatitis. Am Fam Physician. 1999;59(3):625-30.][Daudén E, Bewley A, Lambert J, et al. Expert recommendations: the use of the fixed combination calcipotriol and betamethasone dipropionate gel for the topical treatment of psoriasis. J Eur Acad Dermatol Venereol. 2014;28(Suppl. 2):22-32. DOI:10.1111/jdv.12443][Czock D, Keller F, Rasche FM, Häussler U. Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids. Clin Pharmacokinet. 2005;44(1):61-98. DOI:10.2165/00003088-200544010-00003][He C, Fan H, Tan J, et al. Pharmacokinetics of betamethasone and betamethasone 17-monopropionate in Chinese healthy volunteers after intramuscular injection of betamethasone phosphate/betamethasone dipropionate. Arzneimittelforschung. 2011;61(7):417-20. DOI:10.1055/s-0031-1296220][Salem II, Najib NM. Pharmacokinetics of betamethasone after single-dose intramuscular administration of betamethasone phosphate and betamethasone acetate to healthy subjects. Clin Ther. 2012;34(1):214-20. DOI:10.1016/j.clinthera.2011.11.022][Simon A, de Almeida Borges VR, Cabral LM, de Sousa VP. Development and validation of a discriminative dissolution test for betamethasone sodium phosphate and betamethasone dipropionate intramuscular injectable suspension. AAPS PharmSciTech. 2013;14(1):425-34. DOI:10.1208/s12249-012-9920-2][Zou JJ, Dai L, Ding L, et al. Determination of betamethasone and betamethasone 17-monopropionate in human plasma by liquid chromatography-positive/negative electrospray ionization tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci. 2008;873(2):159-64.][Jobe AH, Milad MA, Peppard T, Jusko WJ. Pharmacokinetics and Pharmacodynamics of Intramuscular and Oral Betamethasone and Dexamethasone in Reproductive Age Women in India. Clin Transl Sci. 2020;13(2):391-9. DOI:10.1111/cts.12724]