JD2609 | Severe Drug Reactions: When a Pill Turns the Immune System Against the Skin

In this episode of the EADV Podcast, Dr. Sarah Walsh is joined by Dr. Saskia Oro (Henri Mondor Hospital, Paris) and Dr. Emmanuel Contassot (University of Basel) to mark the launch of the new EADV CARD-EM Task Force. The conversation opens with the newly published European expert consensus on the diagnosis and management of acute generalised exanthematous pustulosis (AGEP), including how to identify severe cases and when oral corticosteroids are warranted over topical treatment.

They go on to discuss the allergological work-up for AGEP, including patch testing and lymphocyte transformation tests, and the underlying immunology: Dr. Contassot's research showing that IL-36 and an innate immune pathway, rather than T cells alone, help drive the pustules seen in AGEP. The conversation then turns to epidermal necrolysis (SJS/TEN), covering recent research into the roles of macrophages, dendritic cells and IL-33 in disease progression, and what these findings could mean for the field's first targeted therapies.

The episode closes by looking at the long-term impact of SJS/TEN on survivors, drawing on a 2023 Delphi consensus on managing post-acute sequelae and a patient cohort study, both of which point to the same conclusion: the physical and psychological consequences of these diseases can last for decades, and patients need ongoing, multidisciplinary support long after the acute phase has passed.

References:

AGEP European Expert Consensus (2024) Tetart F, Walsh S, Milpied B, et al. Acute generalized exanthematous pustulosis: European expert consensus for diagnosis and management. J Eur Acad Dermatol Venereol. 2024;38(11):2073-2081. doi:10.1111/jdv.20232. 🔗 https://onlinelibrary.wiley.com/doi/10.1111/jdv.20232

Macrophages and Plasmacytoid Dendritic Cells in Epidermal Necrolysis (2025) Saizonou T, et al. Macrophages and plasmacytoid dendritic cells are recruited to the epidermis during epidermal necrolysis. J Eur Acad Dermatol Venereol. 2025. doi:10.1111/jdv.20795. 🔗 https://onlinelibrary.wiley.com/doi/10.1111/jdv.20795

Delphi Consensus on Post-Acute Sequelae of Epidermal Necrolysis (2023) Ingen-Housz-Oro S, Schmidt V, Ameri MM, et al. Post-acute phase and sequelae management of epidermal necrolysis: an international, multidisciplinary DELPHI-based consensus. Orphanet J Rare Dis. 2023;18:33. doi:10.1186/s13023-023-02631-7. 🔗 https://ojrd.biomedcentral.com/articles/10.1186/s13023-023-02631-7