{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T11:51:08Z","timestamp":1771674668111,"version":"3.50.1"},"reference-count":50,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,6,16]],"date-time":"2022-06-16T00:00:00Z","timestamp":1655337600000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Deutsche Derma Gesell"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Stevens\u2010Johnson syndrome and toxic epidermal necrolysis are severe, primarily drug\u2010induced reactions of skin and mucosa. Since they differ in the extent of skin detachment but not in etiology, they are grouped together as epidermal necrolysis (EN). Due to nationwide registration, representative data are available at the German Center for the Documentation of Severe Skin Reactions (dZh). Here, an increasing number of case notifications in the context with new immuno\u2010oncologic drugs, kinase inhibitors and biologics have been observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>Of 4,150 cases notifications between January 2003 and February 2019, 102 cases with exposure to these drug groups underwent systematic analysis, validation and causality assessment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two cases of EN to vemurafenib were confirmed and one case to afatinib and pembrolizumab, respectively. In 14 EN cases other drugs \u2013 predominantly allopurinol or cotrimoxazole \u2013 were the causative agent. Fourteen cases were EN\u2010like reactions: six bullous lichenoid drug eruptions (DE) to pembrolizumab (2), obinutuzumab, nivolumab, rituximab, infliximab\/nivolumab, and eight multiforme\u2010like DE to rituximab (2), adalimumab, ramucirumab, bevacizumab, vemurafenib, sorafenib (2). Lichenoid DE were differentiated from EN through histopathology and by the protracted course of EN, multiforme\u2010like DE by variable skin manifestations with only sparse epidermolysis or mucosal involvement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A correct diagnosis is highly relevant in terms of prognosis and use of these drugs in malignoma treatment. Re\u2010exposure is contraindicated in EN, but possible in other DE after rigorous risk\u2010benefit evaluation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ddg.14711","type":"journal-article","created":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T01:32:39Z","timestamp":1655429559000},"page":"777-786","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Epidermal necrolysis in the context of immuno\u2010oncologic medication as well as kinase inhibitors and biologics"],"prefix":"10.1111","volume":"20","author":[{"given":"Mirjana","family":"Ziemer","sequence":"first","affiliation":[{"name":"Department of Dermatology Venereology and Allergology University Hospital Leipzig  Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viviane","family":"Fries","sequence":"additional","affiliation":[{"name":"German Center for the Documentation of Severe Skin Reactions (dZh) Department of Dermatologie Medical Center and Medical Faculty \u2010 University of Freiburg  Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maren","family":"Paulmann","sequence":"additional","affiliation":[{"name":"German Center for the Documentation of Severe Skin Reactions (dZh) Department of Dermatologie Medical Center and Medical Faculty \u2010 University of Freiburg  Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maja","family":"Mockenhaupt","sequence":"additional","affiliation":[{"name":"German Center for the Documentation of Severe Skin Reactions (dZh) Department of Dermatologie Medical Center and Medical Faculty \u2010 University of Freiburg  Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,6,16]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"733","volume-title":"Fitzpatrick\u2019s Dermatology, 9","author":"Mockenhaupt M","year":"2019"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2020.03.968"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jid.5701033"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2007.08.036"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.2005.00790.x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2017.11.023"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/nm.1884"},{"key":"e_1_2_9_9_1","first-page":"87","article-title":"Severe drug\u2010induced skin reactions: clinical pattern, diagnostics and therapy","author":"Ziemer M","year":"2011","journal-title":"Khopkar U (Hrsg.): Skin Biopsy\u2010Perspectives. InTech, Rijeka"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.5414\/ALX02125"},{"key":"e_1_2_9_11_1","first-page":"723","volume-title":"Fitzpatrick\u2019s Dermatology, 9","author":"Roujeau JC","year":"2019"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.143.6.711"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1159\/000112930"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00105-017-4117-y"},{"key":"e_1_2_9_15_1","unstructured":"ZiemerM.Lichenoid drug eruption (drug\u2010induced lichen planus) \u2013 UpToDate. Available from:https:\/\/www.uptodate.com\/contents\/lichenoid\u2010drug\u2010eruption\u2010drug\u2010induced\u2010lichen\u2010planus[Last accessed August 8 2019]."},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00105-013-2696-9"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2008.09.032"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/DAD.0000000000000688"},{"key":"e_1_2_9_19_1","first-page":"527","volume-title":"Fitzpatrick\u2019s Dermatology, 9","author":"Mangold AR","year":"2019"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/ddg.13876"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/CMR.0000000000000263"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2016.02.015"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/ddg.13412"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2015.2930"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2006.10.981"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1610-0387.2009.07268.x"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.2147\/CMAR.S163391"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2012-0333"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ad.2015.03.008"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.12796"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10637-010-9567-3"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2014-0169"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.2002.03499.x"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2003.44"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1159\/000102604"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2017.07.005"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2007.07682.x"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-011-2212-4"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2016.02.010"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/1346-8138.14205"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdx640"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0053745"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.2009.252"},{"key":"e_1_2_9_44_1","unstructured":"Drug Notoriety for ALDEN from RegiSCAR. Available fromhttp:\/\/www.regiscar.org\/Office_1.html[Last accessed August 30 2019]."},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1981.154"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-15-2872"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdcr.2017.09.028"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijd.13153"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/ced.14060"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar1724"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.18.02141"}],"container-title":["JDDG: Journal der Deutschen Dermatologischen Gesellschaft"],"original-title":[],"language":"de","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ddg.14711","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ddg.14711","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ddg.14711","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T09:47:07Z","timestamp":1692870427000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ddg.14711"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6]]},"references-count":50,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["10.1111\/ddg.14711"],"URL":"https:\/\/doi.org\/10.1111\/ddg.14711","archive":["Portico"],"relation":{},"ISSN":["1610-0379","1610-0387"],"issn-type":[{"value":"1610-0379","type":"print"},{"value":"1610-0387","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6]]},"assertion":[{"value":"2021-07-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-11-30","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}