@article{10.37349/eaa.2026.1009131,
abstract = {Severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP), are T-cell-mediated hypersensitivity reactions. Although their causative agents and acute manifestations are well characterized, limited data exist regarding their long-term sequelae, particularly the subsequent development of autoimmune disease. A comprehensive literature review was conducted using PubMed. Given the limited published evidence regarding autoimmune sequelae following SCARs, the search strategy was intentionally broad and included studies published from the 1980s through 2025. Among SCARs, DRESS demonstrated the strongest association with autoimmune disease, including type 1 diabetes mellitus, thyroiditis, bullous pemphigoid, thrombotic thrombocytopenic purpura, autoimmune hemolytic anemia, vitiligo, and systemic lupus erythematosus. Proposed pathogenic mechanisms include viral reactivation and persistent immune dysregulation. SJS/TEN has also been associated with fulminant type 1 diabetes mellitus, autoimmune thyroid disease, systemic lupus erythematosus, Sjögren’s syndrome, and the development of positive antinuclear antibodies. In contrast, evidence linking AGEP to autoimmune disease remains limited and conflicting, although associations with CARD14 mutations and polyarteritis nodosa have been reported. Evidence supporting post-SCAR autoimmunity, particularly following DRESS, is growing but remains largely based on case reports and small observational studies. SCARs, particularly DRESS and to a lesser extent SJS/TEN, may predispose patients to autoimmune disease through persistent immune dysregulation and viral reactivation. In contrast, no clear association has been established between AGEP and autoimmune disease. Clinicians should remain vigilant for potential long-term autoimmune sequelae following SCARs and consider multidisciplinary follow-up when clinically appropriate. Further prospective studies are needed to better characterize the underlying mechanisms, incidence, and optimal long-term surveillance strategies associated with these conditions.},
author = {Pérez-Westerband, Lydwan and Wang, Keyun and Hernandez, Matthew and Sanchez, David A.},
doi = {10.37349/eaa.2026.1009131},
journal = {Exploration of Asthma & Allergy},
elocation-id = {1009131},
title = {Severe cutaneous adverse reactions and their association with autoimmune disease: an update},
url = {https://www.explorationpub.com/Journals/eaa/Article/1009131},
volume = {4},
year = {2026}
}