Blistering drug eruptions: diagnostic challenges and management in clinical practice unmasking the cause: a grand rounds review of blistering drug eruption

Abstract

Blistering drug eruptions represent a spectrum of severe cutaneous adverse reactions (SCAR) characterized by epidermal and mucosal detachment, which present clinically as vesiculobullous lesions. These conditions, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), bullous fixed drug eruptions and other blistering mimickers, are rare but potentially life-threatening. Prompt recognition and management are critical to improving outcomes. This Grand Rounds review presents two clinical cases of patients presenting with a blistering eruption, guiding the reader through the diagnostic approach, including differential diagnosis and acute management. The differential diagnosis and evaluation of blistering drug eruptions are central, with a focus on distinguishing between drug-, infection-, and autoimmune-induced diseases. A structured, clinical-based approach to these complex reactions can significantly improve patient safety and long-term outcomes.

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