Drug Eruptions Following Treatment with Prodrugs: A Review of the Reported Cases in Japan from 1984 to 1989

A review of 872 cases of drug eruption reported in the Japanese dermatological journals from 1984 to 1989 has revealed a growing subset related to treatment with prodrugs, in which the responsible agent may be the metabolite rather than the prodrug itself. This situation is the result of the presence in tissues and fluids of only the metabolite following absorption and degradation of the prodrug. Because of this condition, patients with drug eruptions after prodrug treatment may develop positive patch test and/or lymphocyte stimulation test reactions not only with the introduced prodrug but also with the metabolite produced in vivo and further with other prodrugs which degrade into the same metabolite.