Antiepileptic medications and cutaneous drug reactions

Antiepileptic drugs (AEDs) have long been associated with a high incidence of cutaneous reactions, none of which are specific to these drugs. This chapter will address three clinically distinct serious cutaneous reactions seen most characteristically with AEDs. Drug reaction with eosinophilia and systemic symptoms (DRESS), also known as Drug-Induced hypersensitivity syndrome (DIHS), is most commonly associated with AEDs. Issues unique to AED-induced DRESS/DIHS include specific clinical manifestations, the contribution of AED metabolism to theories of pathogenesis, and crossreactivity among AEDs. AEDs are an important cause of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN); in some populations carbamazepine is the most commonly associated drug, especially in those with a genetic predisposition. The great majority of Drug-Induced cutaneous pseudolymphoma cases are associated with phenytoin.