In Reply: Severe skin rashes

We thank Drs. Zhang, Wu, and Chen for their interest in our article and their helpful points. We agree that many cases of drug-induced vasculitis are self-limited. But without early recognition, while rare, some cases can present as severe multi-organ involvement.¹ We also agree that a comprehensive analysis of the clinical presentation, history, and laboratory findings is important for diagnosing the etiology of a drug rash. While not all severe skin rashes require biopsy, for the 4 diagnoses we reviewed, when there is initial diagnostic uncertainty, we believe skin biopsy is usually a helpful best next step.

Finally, we agree that acute generalized exanthematous pustulosis is primarily diagnosed with clinical, laboratory, and sometimes histologic criteria, often with the support of the European Study of Severe Cutaneous Adverse Reactions diagnostic score. Dermoscopy may help in early stages of disease, although we certainly agree this would be just 1 small part of the diagnostic evaluation.²

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