Eczematous drug eruptions are a heterogenous group of pruritic, eczematous reactions that occur after exposure to a variety of medications, even in patients without prior eczematous dermatitis. Some medications frequently implicated include calcium channel blockers, thiazides, anti-tumor necrosis factor (TNF)-alpha agents, the IL-23 inhibitors guselkumab and ustekinumab, antiviral medications (such as peginterferon / ribavirin and telaprevir), immunomodulatory agents (including everolimus, temsirolimus, and tacrolimus), chemotherapies (including the multikinase inhibitors sorafenib, regorafenib, and imatinib; the epidermal growth factor receptor [EGFR] inhibitors gefitinib, erlotinib, cetuximab, and panitumumab; and anti-PD-1 checkpoint inhibitors nivolumab and pembrolizumab), and intravenous immunoglobulin (IVIG).

Eczematous eruptions are more common in older adults, perhaps due to changes with aging that make the skin more vulnerable, such as atrophy and decreased glandular secretions. In some cases, drug eruptions may be the underlying cause of chronic eczematous eruptions of the aged.

The time course for developing an eczematous reaction is highly dependent on the inciting medication, with mean onset of the reaction varying from days to several months after exposure.

The prognosis is quite good, but intense pruritus and relapse after topical immunosuppressive therapy may lead to hospitalization. In one case series, for example, 20% of patients with chronic eczematous eruptions of the aged required hospitalization.

Related topics: EGFR inhibitor-induced acneiform eruption, anti-TNF-alpha-induced eruptions, cutaneous adverse effects of anti-PD-1 and anti-PD-L1 therapy