Cutaneous adverse drug reactions to anti-tuberculosis drugs: state of the art and into the future

Abstract

First- and second-line anti-tuberculosis drugs are associated with a diverse presentation of cutaneous adverse drug reactions (CADR), ranging from mild to life threatening. An individual drug can cause multiple types of CADR, and a specific type of CADR can be due to any anti-tuberculosis drug, which can make the management of tuberculosis (TB) following CADR challenging. The higher incidence of TB and CADR in HIV-infected persons makes TB-associated CADR a burgeoning problem for clinicians, particularly in high HIV-prevalence settings. This review discusses the pathogenesis, epidemiology, clinical presentation, diagnosis and management of TB-associated CADR. Clinical controversies including its impact on treatment outcomes, challenges in restarting optimal anti-tuberculosis therapy and the timing of highly active antiretroviral therapy initiation in those with HIV coinfection are also discussed. Finally, gaps in the current knowledge of TB-associated CADR have been identified and a research agenda has been proposed.

Keywords::

• adverse reactions
• management
• skin
• therapy
• tuberculosis

Financial & competing interests disclosure

RJ Lehloenya is supported by the Discovery Foundation, Dermatological Society of South Africa and is a recipient of Carnegie Corporation Infectious Disease award. K Dheda is supported by the South African National Research Foundation, the South African Medical Research Council, EU FP7 and the European and Developing Countries Clinical Trials Partnership (EDCTP). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

Data taken from [67].

CADR: Cutaneous adverse drug reactions; HAART: Highly active antiretroviral therapy; TB: Tuberculosis.