Drug-Induced Neutropenia During Treatment of Non-Neoplastic Dermatologic Diseases: A Review
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REVIEW ARTICLE
Drug‑Induced Neutropenia During Treatment of Non‑Neoplastic Dermatologic Diseases: A Review Chang‑Yu Hsieh1 · Tsen‑Fang Tsai2
© Springer Nature Switzerland AG 2020
Abstract Idiosyncratic drug-induced neutropenia (DIN) is a rare, potentially fatal adverse reaction. A literature search was performed on Pubmed and Embase, targeting articles indicating neutropenia as a complication during the treatment of non-neoplastic dermatological disorders. In 66 identified articles, the common incriminated drugs included conventional oral immunomodulators, topical cytotoxic agents, antibacterials, antifungals, biologics and targeted synthetic disease-modifying antirheumatic drugs, non-steroidal anti-inflammatory drugs, and retinoids, with dapsone being reported most often. The duration of drug exposure before the diagnosis of neutropenia varied, but mostly ranged from days to weeks. The majority of patients recovered after drug discontinuation and supportive management including antibiotics and granulocyte colony-stimulating factor, but fatal cases were reported. The proposed pathogenesis of DIN consists of direct drug toxicity and immune-mediated reaction. Certain genetic variants, individual variability in enzyme efficiency, and concomitant use of other drugs may increase the risk of DIN. Being familiar with the most commonly implicated agents and risk factors helps early identification and prompt management of this potentially fatal complication.
Key Points
1 Introduction
The common drugs causing neutropenia in the dermatological field include conventional oral immunomodulators, topical cytotoxic agents, antibacterials, antifungals, biologics and targeted synthetic disease-modifying antirheumatic drugs, non-steroidal anti-inflammatory drugs, and retinoids.
Drugs such as chemotherapeutic agents may result in neutropenia through direct cytotoxicity. However, some nonchemotherapeutic agents could lead to neutropenia in susceptible patients. Idiosyncratic drug-induced neutropenia (DIN) is a rare, sporadic, and usually transient disorder. The clinical presentation of DIN varies in severity, ranging from asymptomatic, mucositis, alopecia, fever, chills, sore throat, myalgia, joint pain, pneumonia, septicemia, and even death [1, 2]. Skin manifestations of DIN are usually non-specific with cutaneous infection reported the most [3]. There have been several articles investigating the cause, diagnosis, and management of DIN [1, 4, 5], but a comprehensive review of DIN of dermatological interest is lacking. As the occurrence of DIN in patients not receiving chemotherapeutic agents is rare and unpredictable, with potentially fatal consequences, we summarized reports and recent progress of DIN in nonneoplastic dermatologic diseases.
Clinical alertness should be maintained when using these medications.
* Tsen‑Fang Tsai [email protected] 1
Department of Medical Education, National Taiwan University Hospital, No.7, Zhongshan S. Rd Zhongzheng Dist., Taipei City 100, Taiwan, ROC
Department of Dermatology, Nationa
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