Critical Review of Gaps in the Diagnosis and Management of Drug-Induced Liver Injury Associated with Severe Cutaneous Adverse Reactions

Drug-induced liver injury (DILI) encompasses the unexpected damage that drugs can cause to the liver. DILI may develop in the context of an immunoallergic syndrome with cutaneous manifestations, which are sometimes severe (SCARs). Nevirapine, allopurinol, anti-epileptics, sulfonamides, and antibioti...

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Autores principales:	Marina Villanueva-Paz, Hao Niu, Antonio Segovia-Zafra, Inmaculada Medina-Caliz, Judith Sanabria-Cabrera, M. Isabel Lucena, Raúl J. Andrade, Ismael Alvarez-Alvarez
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	drug-induced liver injury severe cutaneous adverse reactions hypersensitivity gaps causality assessment diagnosis Medicine R
Acceso en línea:	https://doaj.org/article/0e7d4805616d4ae79bc60801e6765a19
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spelling	oai:doaj.org-article:0e7d4805616d4ae79bc60801e6765a192021-11-25T18:01:38ZCritical Review of Gaps in the Diagnosis and Management of Drug-Induced Liver Injury Associated with Severe Cutaneous Adverse Reactions10.3390/jcm102253172077-0383https://doaj.org/article/0e7d4805616d4ae79bc60801e6765a192021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5317https://doaj.org/toc/2077-0383Drug-induced liver injury (DILI) encompasses the unexpected damage that drugs can cause to the liver. DILI may develop in the context of an immunoallergic syndrome with cutaneous manifestations, which are sometimes severe (SCARs). Nevirapine, allopurinol, anti-epileptics, sulfonamides, and antibiotics are the most frequent culprit drugs for DILI associated with SCARs. Interestingly, alleles HLA-B58:01 and HLA-A31:01 are associated with both adverse reactions. However, there is no consensus about the criteria used for the characterization of liver injury in this context, and the different thresholds for DILI definition make it difficult to gain insight into this complex disorder. Moreover, current limitations when evaluating causality in patients with DILI associated with SCARs are related to the plethora of causality assessment methods and the lack of consensual complementary tools. Finally, the management of this condition encompasses the treatment of liver and skin injury. Although the use of immunomodulant agents is accepted for SCARs, their role in treating liver injury remains controversial. Further randomized clinical trials are needed to test their efficacy and safety to address this complex entity. Therefore, this review aims to identify the current gaps in the definition, diagnosis, prognosis, and management of DILI associated with SCARs, proposing different strategies to fill in these gaps.Marina Villanueva-PazHao NiuAntonio Segovia-ZafraInmaculada Medina-CalizJudith Sanabria-CabreraM. Isabel LucenaRaúl J. AndradeIsmael Alvarez-AlvarezMDPI AGarticledrug-induced liver injurysevere cutaneous adverse reactionshypersensitivitygapscausality assessmentdiagnosisMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5317, p 5317 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	drug-induced liver injury severe cutaneous adverse reactions hypersensitivity gaps causality assessment diagnosis Medicine R
spellingShingle	drug-induced liver injury severe cutaneous adverse reactions hypersensitivity gaps causality assessment diagnosis Medicine R Marina Villanueva-Paz Hao Niu Antonio Segovia-Zafra Inmaculada Medina-Caliz Judith Sanabria-Cabrera M. Isabel Lucena Raúl J. Andrade Ismael Alvarez-Alvarez Critical Review of Gaps in the Diagnosis and Management of Drug-Induced Liver Injury Associated with Severe Cutaneous Adverse Reactions
description	Drug-induced liver injury (DILI) encompasses the unexpected damage that drugs can cause to the liver. DILI may develop in the context of an immunoallergic syndrome with cutaneous manifestations, which are sometimes severe (SCARs). Nevirapine, allopurinol, anti-epileptics, sulfonamides, and antibiotics are the most frequent culprit drugs for DILI associated with SCARs. Interestingly, alleles HLA-B58:01 and HLA-A31:01 are associated with both adverse reactions. However, there is no consensus about the criteria used for the characterization of liver injury in this context, and the different thresholds for DILI definition make it difficult to gain insight into this complex disorder. Moreover, current limitations when evaluating causality in patients with DILI associated with SCARs are related to the plethora of causality assessment methods and the lack of consensual complementary tools. Finally, the management of this condition encompasses the treatment of liver and skin injury. Although the use of immunomodulant agents is accepted for SCARs, their role in treating liver injury remains controversial. Further randomized clinical trials are needed to test their efficacy and safety to address this complex entity. Therefore, this review aims to identify the current gaps in the definition, diagnosis, prognosis, and management of DILI associated with SCARs, proposing different strategies to fill in these gaps.
format	article
author	Marina Villanueva-Paz Hao Niu Antonio Segovia-Zafra Inmaculada Medina-Caliz Judith Sanabria-Cabrera M. Isabel Lucena Raúl J. Andrade Ismael Alvarez-Alvarez
author_facet	Marina Villanueva-Paz Hao Niu Antonio Segovia-Zafra Inmaculada Medina-Caliz Judith Sanabria-Cabrera M. Isabel Lucena Raúl J. Andrade Ismael Alvarez-Alvarez
author_sort	Marina Villanueva-Paz
title	Critical Review of Gaps in the Diagnosis and Management of Drug-Induced Liver Injury Associated with Severe Cutaneous Adverse Reactions
title_short	Critical Review of Gaps in the Diagnosis and Management of Drug-Induced Liver Injury Associated with Severe Cutaneous Adverse Reactions
title_full	Critical Review of Gaps in the Diagnosis and Management of Drug-Induced Liver Injury Associated with Severe Cutaneous Adverse Reactions
title_fullStr	Critical Review of Gaps in the Diagnosis and Management of Drug-Induced Liver Injury Associated with Severe Cutaneous Adverse Reactions
title_full_unstemmed	Critical Review of Gaps in the Diagnosis and Management of Drug-Induced Liver Injury Associated with Severe Cutaneous Adverse Reactions
title_sort	critical review of gaps in the diagnosis and management of drug-induced liver injury associated with severe cutaneous adverse reactions
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/0e7d4805616d4ae79bc60801e6765a19
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Critical Review of Gaps in the Diagnosis and Management of Drug-Induced Liver Injury Associated with Severe Cutaneous Adverse Reactions

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