Cutaneous Adverse Drug Reactions Caused by Antituberculosis Drugs
Saida Rezakovic, Zrinjka Pastar and Kresimir Kostovic
Affiliation: Department of Dermatovenerology, University Hospital Center Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia.
Keywords: Antituberculosis drug intolerance, cutaneous adverse drug reactions, drug hypersensitivity, rechallenge,
reintroduction, skin toxicities.
Multidrug antituberculosis regimen is associated with diverse clinical patterns of cutaneous adverse drug
reactions (CADR), ranging from mild and moderate such as pruritus, maculopapular exanthems, lichenoid eruptions, fixed
drug eruptions and urticaria to severe and even life threatening ones like acute generalized exanthematous pustulosis
(AGEP), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). These adverse reactions to
antituberculosis drugs are commonly observed adverse events. This is of particular importance for high HIV prevalence
settings and developing countries where tuberculosis is common infection resulting in higher occurrence rate of these
reactions. There is still significant heterogenity in definition and classification of CADR, as well as diversity in treatment
modalities following adverse reactions and rechallenge management.
The aim of this review is to discuss clinical presentation, occurrence of CADR caused by antituberculosis drugs, to
identify risk factors for intolerance of the standard therapy as well as to draw attention to importance of multi-disciplinary
approach, early detection, prompt diagnosis and in time management of antituberculosis drugs associated CADR. CADR
can cause significant treatment interruption and alteration, resulting in increased risk of treatment failure, drug resistance,
relapses and increased risk of complications including even lethal outcome. Finally, it can be concluded that it is of great
importance to identify the best possible treatment and preventive regimens in order to enable continuity of the
antituberculosis therapy to the full extent.
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