Dr Scott Jackson explored how common medications can lead to protean cutaneous morphologies, often mimicking different skin diseases. He highlighted some of the most-talked-about drug-induced cutaneous disorders and provided some classical and some surprising associations. The session began with a discussion of drug-induced dermatomyositis (DM), which has been associated with hydroxyurea, immune checkpoint inhibitors, and statins. Statins received particular attention. Although typically used to lower cholesterol through inhibition of HMG-CoA reductase, statin exposure can trigger an autoimmune response, leading to the production of anti–HMGCR antibodies. These antibodies target muscle tissue, resulting in necrotizing autoimmune myositis and a cutaneous eruption that overlaps with features of DM.
Next, Dr Jackson covered drug-induced cutaneous lupus (DI-SCLE). Over the past decade, several medications have been implicated, including anti-TNF alpha agents, immune checkpoint inhibitors, and proton pump inhibitors (PPIs). Notably, PPIs have been increasingly linked to a wide range of cutaneous reactions, from fixed drug eruptions to acute generalized exanthematous pustulosis (AGEP).
He then discussed drug-induced asteatosis and eczematous dermatoses, citing associations between statins and diuretics with xerosis cutis, amlodipine with stasis dermatitis, calcium channel blockers with eczema, statins with eczematous dermatitis, and IVIG with dyshidrotic eczema. The lecture continued with an overview of drug associations with psoriasiform dermatitis and drug-induced psoriasis, including lithium, antimalarials, oral and topical beta-blockers, terbinafine, and, more recently, checkpoint inhibitors, TNF–alpha inhibitors, and bupropion.
Dr Jackson also addressed drug-induced alopecia areata (DI-AA) associated with some of the most common monoclonal antibody therapies in dermatology. Drug-induced bullous pemphigoid (DI-BP) was another major topic. In one retrospective review, 20% of BP cases were drug-induced. Suspected culprits were dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors), furosemide, monoclonal antibodies used for psoriasis, and immune checkpoint inhibitors. The lecture concluded with a comprehensive review of other drug-related dermatologic conditions, including fixed drug and food eruptions, lichenoid drug eruptions, drug-induced pseudo-lymphoma, pseudo-porphyria, DRESS syndrome, drug-induced vascular disorders, and drug-induced delusional parasitosis. Overall, through his lecture Dr Jackson emphasized the importance of maintaining a high index of suspicion for drug-induced causes when evaluating dermatologic conditions.