Hypersensitivity reactions induced by aromatic antiseizure medications: a narrative review

Cutaneous drug reactions are a subset of drug hypersensitivity reactions (DHRs) that predominantly involve the skin, ranging from mild exanthemas to severe cutaneous adverse reactions (SCARs). They represent clinically significant events, with the potential for severe and even fatal outcomes. Among the various drugs associated with these reactions, aromatic antiseizure medications (ASMs) are particularly noteworthy, as their use has been linked to severe conditions such as Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS). Recent advances in pharmacogenetics have sought to further elucidate the underlying pathophysiological mechanisms of cutaneous drug reactions, as well as to inform optimal management and diagnostic strategies. This narrative review aims to discuss the pathophysiology, clinical presentation, diagnostic approaches, and treatment of cutaneous DHRs associated with aromatic ASMs with a clinical approach for physicians managing patients presenting these conditions.