Drug-induced Papuloerythroderma: Analysis of T-cell Populations and a Literature Review

Papuloerythroderma of Ofuji is characterized by coalescent solid papules that spare the skin folds. Although cutaneous lymphomas and internal malignancies are known associated conditions, the causative agents are unclear in most cases. A number of recent reports have documented that drugs can induce papuloerythroderma. We reviewed the reported cases and our own cases of drug-induced papuloerythroderma, together with our data from lymphocyte transformation tests and T-cell subsets of peripheral blood. All of the 9 patients were male, and the causative drugs were various. Provocation tests were positive in all 6 patients examined. Whereas drug patch tests were negative in all 5 cases tested, the patients' peripheral blood lymphocytes responded well to the culprit drug in 4 of 5 patients tested. The patients had higher percentages of circulating CCR4(+)CD4(+) T helper (Th) 2 cells than CXCR3(+)CD4(+) Th1 cells. Drug-induced papuloerythroderma seems to be mediated by Th2 cells reacting with the causative drug.