45 - Cutaneous Reactions to Drugs

Question 1

Exanthematous eruptions account for approximately _____% of skin reactions

Answer 1

95

Question 2

Exanthematous eruptions typically starts on the

Answer 2

Trunk

Question 3

Y/N: Pruritus is almost always absent in exanthematous eruptions.

Answer 3

No - present

Question 4

Examples of drug-virus interaction

Answer 4

Infectious mononucleosis - aminopenicillin

HIV - sulfonamide antibiotics

Question 5

Exanthematous eruption in conjunction with fever and internal organ inflammation

Answer 5

Hypersensitivity syndrome reaction or
Drug-induced hypersensitivity syndrome or
Drug reaction with eosinophilia and systemic symptoms

Question 6

HSR occurs most frequently on _____ exposure

Answer 6

First

Question 7

Often the presenting symptoms of hypersensitivity syndrome reaction

Answer 7

Fever

Malaise

Question 8

Possible long-term complication of HSR

Answer 8

Immune-mediated thyroid dysfunction

Question 9

When deep dermal and subcutaneous tissues are also swollen, the reaction is known as

Answer 9

Angioedema

Question 10

Frequently unilateral and nonpruritic and lasts for 1-2 hours

Answer 10

Angioedema

Question 11

Drug-induced IgE-mediated immediate hypersensitivity causes

Answer 11

Penicillin

Other antibiotics

Question 12

Drug-induced non-IgE-mediated immediate hypersensitivity causes

Answer 12

NSAIDs

ACE inhibitors

Question 13

Defined by the presence of fever, rash (usually urticarial) and arthralgias

Answer 13

Serum sickness-like reactions

Question 14

Associated with an increased relative risk of serum sickness-like reactions

Answer 14

Cefaclor

Question 15

Previous hormonal priming is a necessary prerequisite in

Answer 15

Acneiform eruptions

Question 16

Do not affect prepubertal children

Answer 16

Acneiform eruptions

Question 17

There is contradictory evidence for the benefit of _____ for prophylaxis for acneiform eruptions

Answer 17

Tetracyclines

Question 18

AGEP is an acute febrile pustular eruption that occurs _____ hours after initiation of the implicated drug

Answer 18

24-48

Question 19

In AGEP, sterile pustules are concentrated on the

Answer 19

Trunk

Intertriginous areas

Question 20

Usual treatment necessary in most patient with AGEP

Answer 20

Discontinuance of therapy

Question 21

Pseudoporphyria is a cutaneous phototoxic disorder that can resemble either _____ in adults or _____ in children

Answer 21

Porphyria cutanea tarda

Erythropoietic protoporphyria

Question 22

Pseudoporphyria differs from porphyria cutanea tarda and erythropoietic protoporphyria by the presence of

Answer 22

Normal porphyrin levels

Question 23

Drug-induced vs idiopathic linear IgA disease

Answer 23

Mucosal or conjunctival lesions are less common
Spontaneous remission occurs once offending agents is removed
Immune deposits disappear once the lesions resolve

Question 25

Most frequently reported cause of drug-induced linear IgA disease

Answer 25

Vancomycin

Question 26

Drug-induced vs idiopathic bullous pemphigoid

Answer 26

``` Younger patients May have positive Nikolsky sign Lesions on normal-appearing skin Target lesions on palns and soles Involvement of the lower legs Mucosal involvement ```

Question 27

FDE in women more commonly presenting with lesions on the ______, and men on the ______

Answer 27

Hands and feet | Genitalia

Question 28

FDE may exhibit _____, a sign of incipient blister formation

Answer 28

Epidermal wrinkling

Question 29

Most frequent culprits for FDE

Answer 29

NSAIDs Acetaminophen Antibioticso

Question 30

Drug-induced vs idiopathic lichen planus

Answer 30

Often appear initially as eczematous with a purple hue Involve large areas of the trunk Mucous membranes and nails are not involved

Question 31

Systemic symptons associated with drug-induced pseudolymphoma

Answer 31

Fever Marked lymphadenopathy Hepatosplenomegaly Eosinophilia

Question 32

Y/N: Most patients with drug-induced lupus have no cutaneous findings of lupus erythematosus.

Answer 32

Yes

Question 33

Most common serologic abnormality in drug-induced lupus

Answer 33

Positivity for ANA with a homogeneous pattern

Question 34

Unlike in idiopathic lupus erythematosus, _____ are typically absent, whereas _____ are often present

Answer 34

anti-dsDNA | anti-ssDNA

Question 35

Causes of drug-induced lupus

Answer 35

``` Hydralazine Procainamide Isoniazid Methyldopa Minocycline ```

Question 36

Most common drugs associated with SCLE

Answer 36

Terbinafine Thiazide diuretics Calcium channel blockers Ranitidine

Question 37

Drug-induced dermatomysitis causes

Answer 37

Hydroxyurea Penicillamine HMG-CoA reductase inhibitors

Question 38

Drug-induced vasculitis represents approximately _____% of the acute cutaneous vasculitides

Answer 38

10

Question 39

Drug-induced vs other causes of vasculitis

Answer 39

Less progression to glomerulonephritis Better outcomes Require less immunosuppressive treatment

Question 40

Anticoagulant-induced skin necrosis develop in

Answer 40

Adipose-rich sites such as breasts, buttocks, and hips

Question 41

Incidence of anticoagulant-induced skin necrosis is higher in

Answer 41

Women, majority of whom are obese

Question 42

Treatment for neutrophilic eccrine hidradenitis

Answer 42

Colchicine

Question 43

Prophylactic treatment for neutrophilic eccrine hidradenitis

Answer 43

Dapsone

Question 44

New drugs started with the preceding 3 months are potential causative agents except in

Answer 44

Drug-induced lupus Drug-induced pemphigus Drug-induced cutaneous pseudolymphoma

Question 45

IgE-mediated; immediate-type immunologic reactions

Answer 45

Type 1

Question 46

Drug + cytotoxic antibodies cause lysis of cells such as platelets or leukocytes

Answer 46

Type II

Question 47

IgG or IgM antibodies formed to drug; immune complexes deposited in small vessels active complement and recruit granulocytes

Answer 47

Type III

Question 48

Cell-mediated immune reaction; sensitized lymphocytes react with drug, liberating cytokines, which trigger cutaneous inflammatory response

Answer 48

Type IV

Question 49

Type of reaction: Urticaria/angioedema

Answer 49

Type I

Question 50

Type of reaction: Petechiae resulting from thrombocytopenic purpura

Answer 50

Type II

Question 51

Type of reaction: Drug-induced pemphigus

Answer 51

Type II

Question 52

Type of reaction: Vasculitis

Answer 52

Type III

Question 53

Type of reaction: Urticaria

Answer 53

Type III

Question 54

Type of reaction: Serum sickness

Answer 54

Type III

Question 55

Type of reaction: Morbilliform exanthematous reactions

Answer 55

Type IV

Question 56

Type of reaction: Fixed drug eruption

Answer 56

Type IV

Question 57

Type of reaction: Lichenoid eruptions

Answer 57

Type IV

Question 58

Type of reaction: SJS-TEN

Answer 58

Type IV

Question 59

Patch testing has greater sensitivity if performed

Answer 59

Over a previously involved area of skin

Question 60

SCORTEN criteria is calculated within

Answer 60

First 24 hours of admission

Question 61

SCORTEN criteria

Answer 61

``` Age older than 40 years Urea < 10 mmol/L Glucose > 14 mmol/L Bicarbonate < 20 mEq/L Heart rate > 120 bpm Presence of malignancy BSA > 10% at presentation ```

Question 62

SCORTEN mortality ranging from _____% (1 point) to _____% (5 points)

Answer 62

3.2 | 90

Question 63

Index of suspicion of drug induction in linear IgA disease should be higher in cases with

Answer 63

Only IgA and no IgG in the basement membrane zone