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Dermatology > Contact Dermatitis/ Drug Eruptions > Flashcards

Contact Dermatitis/ Drug Eruptions Flashcards

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Dermatology Board Prep flashcards
1
Q

Produces parasthesias of fingertips, cyanosis, gangrene

A

Oxalic acid

Neutralized by limewater or milk of magnesia

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2
Q

Produces a white eschar

May cause glomerulonephritis or arrythmias

A

Phenol (carbolic acid)

Neutralized by ethyl or isopropyl alcohol

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3
Q

Hydrofluoric acid

A

Neutralize periungual burns with IL calcium gluconate

May cause low Ca, low Mg, high K and dysrrythmias

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4
Q

Lime, arsenic, zinc dust

A

May produce folliculitis

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5
Q

Hyperpigmentation, keratoses, scrotal cancer

A

InSoluble cutting oils

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6
Q

Acne corne

A

Follicular keratosis and pigmentation from crude petroleum

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7
Q

Acquired perforating dermatosis in field workers

A

Calcium chloride

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8
Q

Inhalation causes exfoliative erythroderma, eosinophilia, mucous membrane erosions and hepatitis

A

Trichloroethylene used as degreasing agent and dry cleaning

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9
Q

Contact urticaria

A

Cetyl amd stearyl alcohol

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10
Q

Produce a pustular eruption on patch testing of no clinical significance

A

Nickel, mercury, potassium iodide

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11
Q

Other toxicodendron reactors

A

Cashew (nutshell), rengas tree, spider flower, silver oak

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12
Q

Rescorcinol allergy

A

Person is elliptical, wheat bran, marine brown algae

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13
Q

Prevents or diminishes poison ivy

A

Quaterinium 18 bentonite

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14
Q

Sites of early mango dermatitis

A

Eyelids and prepuce bc from palms

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15
Q

Ingestion of ginkgo fruit results in

A

Perianal dermatitis

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16
Q

Most common cause of allergic dermatitis in florists

A

Peruvian lily

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17
Q

Antigenic site of sesquiterpene

A

Alpha methylene portion

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18
Q

Causes a severe inflammatory bullous rxn

A

Prairie crocus

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19
Q

Contact urticaria and anaphylaxis

A

Onion and celery

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20
Q

Cause erythema multiforme

A

Tea tree oil, cocobolo, rosewood (exotic woods), Bermuda fire sponge

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21
Q

Seaweed dermatitis

A

Blue green algae (lyngbya), within minutes, area covered

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22
Q

Sabra dermatitis

A

Prickly pear and fig

Resembles scabies

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23
Q

Pastry baker hand dermatitis

A

Cinnamon

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24
Q

Dentist dermatitis

A

Eugenol, clove oil, eucalyptus oil

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25
Q

Allergic sensitizerbof turpentine

A

Carlene

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26
Q

Best screening agents for clothing dermatitis

A

Ethylene urea melamine formaldehyde resin, dimethylol dihydroxyethylene

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27
Q

Shoe dermatitis

A

Rubber accelerators like mercaptobenzothiazole, carbamates, tetramethylthiuram disulfide, K dichromate

*spares web spaces

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28
Q

Black dermatographism

A

Under jewelry containing zinc, titanium oxide on gold jewelry

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29
Q

Addition of this to cement decreases chrome dermatitis

A

Ferrous sulfate

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30
Q

Most common component of thimersol to cause ACD

A

Ethyl mercuric

*those who react to thiosalicilic acid component have piroxicam allergy

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31
Q

Glove allergy

A

Thiuram

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32
Q

Dental bonding agents

A

Bisphenol A and glycidyl methacrylate

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33
Q

Orthopedist allergy

A

Methyl methacrylate monomer

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34
Q

Most common fragrance allergies

A

Cinnamic alcohol, oak moss, cinnamic aldehyde, hydroxy citronellal, musk ambrette, isoeugenol, geraniol, coumarin, Lyral, eugenal

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35
Q

What color of hair dyes cross react with PPD

A

Azo dyes - acid violet 6b, water soluble nigrosine, ammonium carbonate

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36
Q

May produce a localized urticarial and generalized histamine reaction

A

Ammonium persulfste

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37
Q

Allergin of propolis (lip balm, lipstick)

A

Caffeates

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38
Q

Highest rate of allergy among transdermal meds

A

Clonidine

*TD meds may have EM like reaction

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39
Q

Anamnestic reaction (recall if sensitized topically then taken internally flare at previous site of ACD)

A

Antihistamines
Sulfonamides
PCN

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40
Q

Late patch reaction, 7 d

A

Neomycin

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41
Q

Topical ab with highest rate of contact urticaria and anaphylaxis

A

Bacitracin

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42
Q

Highest rates of occupational skin disease

A

Agriculture, fishing, forestry

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43
Q

MC cause of contact urticaria

A

Nonimmunologic - no prior sensitization

Causes - nettle, DMSO, sorbic acid, benzoic acid, cinnamic aldehyde, cobalt, trafuril

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44
Q

Immunologic urticaria

A

Latex, potatoes, phenylmercuric propionate

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45
Q

Groups with highest risk of latex allergy (type 1)

A

Atopic and spina bifida

Banana, avocado, kiwi, chestnut, passion fruit
Open patch tests best for immediate type hypersensitivity
Rast detects 75% of latex allergy

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46
Q

MC drug allergy

A 
Simple exanthems
F MC, except males under 3
Occur within 2 weeks but up to 10 d after stopping drug
PCNs and Bactria MC
May have UV recall
47
Q

Type 1 hypersensitivity

A

Skin testing useful

48
Q

Cells imp in patho of ADR

A

Th1

49
Q

Bullous drug without epidermal necrosis

A

Th1- induce IFN gamma

50
Q

Th2

A

Morbilliform and urticarial

Others
CD8 which secrete perforin, granzyme B and FAS ligand causing keratinocytes apoptosis, most dangerous

T cells via GM-CSF and IL8 for agep

51
Q

Treg markers

A

Dermal CD4+CD25+foxp3 regulatory T cells reduced in bullous drug eruptions like ten

*tregs with skin homing molecules inreased in early drug hypersensitivity - immunologically active early to suppress immune function but become functionally deficient ( explains autoimmune sequela later in dress)

52
Q

Sulfa dress crossreactors

A

Long acting sulfonamides - sulfamethoxazole, sulfadiazine, sulfasalazine

NOT sulfonylureas, thiazides, furosemide or acetazoleamide

53
Q

Early and late dress findings

A

Early - interstitial nephritis

Late - SIADH, graves, DM, SLE

54
Q

COD in dress

A

Liver or renal

55
Q

Directly induces HHV6

A

Sodium valproate *one study showed all fatal dress cases associated with HHV6 reactivation

56
Q

MC AED to cause dress

A

Carbamazepine

*hhv6 and 7 reactivation more commonly seen with carb

57
Q

MC finding in anticonvulsant hypersensitivity syndrome

A

Fever (50%) adenpoathy (20%), elevated LFT’s ( btw 2/3 and 3/4 of cases)

58
Q

Lamotrogine dress

A

Less eosinophilia, LAD and multi organ involvement
Usually occurs within 4 week, may take up to 6 months
Coadministration of valproate increases risk of lamotrigine dress
Slow introduction decreases the risk

59
Q

Safe alternative for anticonvulsant hypersensitivity

A

Valproate

60
Q

Allopurinol hypersensitivity

A

Normal occurs in the setting of renal failure
MCC of death - CV (25%)
Pancreatitis and DM may develop
Dialysis does not hasten resolution of the eruption

61
Q

Sulfonamides hypersensitivity due to?

What AED cross reacts?

A

Slow acetylators

Zonisamide (but not with other AEDs)

62
Q

HLA in allopurinol hypersensitivity

A

HLA-B-5801 in Han Chinese

63
Q

Minocycline hypersensitivity

A

Deficiency of glutathione a transferase common
Typically begins 2-4 weeks later
Fever, rash and LAD in >80%
HA and cough common
Liver inv in 75%
*particularly associated with interstitial pneumonia with eosinophilia

64
Q

Dapsone hypersensitivity

A

Usually begins 4 or more weeks later
Icterus and LAD in 85%
Eosinophilia typically NOT present
Elevated bili in 85% (partially from hemolysis)
Liver inv mixture of hepatocellular and cholestatic
Low albumin is characteristic

65
Q

Han Chinese hla in SJS/TEN

A

HLA-B-1502

66
Q

MCC of SJS in kids

A

Sulfonamides - MC in spring

67
Q

Not part of scorten but bad prognostic indicator

A

Respiratory involvement

68
Q

May precede SJS

A

Fever and flu like eruption

69
Q

Level correlates with BSA involvement in SJS

A

Soluble Fas Ligand

70
Q

MC sequale of SJS

A

Ocular scarring and vision loss

*other include cutaneous scarring, eruptivr nevi, nail abnormalities, transient widespread verrucous hyperplasia resembling SK’s

71
Q

Radiation induced erythema multiforme

A

Occurs in NSG pts on phenytoin and steroids who get full brain XRT
Spreads caudad a similar syndrome seen with amifostine

72
Q

Cd4 count in HIV with high rate of ADR

A

25-200

Hepatitis but not cutaneous reactions MC if cd4 is above 200

73
Q

Increased risk of SJS

A

Nevirapine, especially HLA-DRB1*0101

74
Q

Abacavir hypersensitivity

A

HLA-B*5701

75
Q

MC location of fixed drug

A

1/2 are oral or genital (erosive symmetric vulvitis)

76
Q

Cause of FDE with predilection for lips

A

NSAIDS - especially pyrazolinr derivavtives, paracetamol, naproxen, oxicams and mefenamic acid

*cause of majority of genital FDE - sulfonamides

77
Q

Causes of FDE

A

NSAIDS, sulfonamides, barbiturates, TCN, phenolphthalein (laxatives), acetaminophen, cetirizine, celecoxib, dextromethorphan, hydroxyzine, quinine, lamotirigine, phenylpropanolamine, erythromycin, herbs

78
Q

HLA linked to FDE

A

HLA-B22

79
Q

What increases the likelihood of positive patch tests in FDE

A

Tape stripping

80
Q

2 variants of nonpigmenting FDE

A

1) pseudocellulitis or Scarlatiniform

2) SDRIFE - giant cell lichenoid derm on path

81
Q

Cell found in FDE

A

Intraepi CD8 which secretes IFN gamma

*once the med is stopped tregs clear (found fewer in number in SJS explaining persistence of rxn)

82
Q

AGEP

A

Strong F predominance
Mediated by T cells which produce IL8, IFN gamma, IL4, IL5 and GM-CSF
Mercury exposure, viral/back infections, loxoceles bite, radiocontrast
>90% due to drug - amp/Amox, pristinamycin, quinolone, hydroxychloroquine, sulfonamides ab, terbinafine, imatinib, diltiazem
Fever and MM inv common (non erosive), neutrophilia > eosinophilia
Patch testing pos in 50%

83
Q

Most common drug induced pseudolyphmphoma

A

Resembles CTCL, TCR may be positive

AEDs, sulfa (including thiazides), dapsone, antidepressants, vaccines, herbs

84
Q

MCC of nonimmunologic urticaria

A

Aspirin and NSAIDs

*trilisate and salsate do not cross react

85
Q

MCC of immunologic urticaria

A

PCN

Skin testing useful

86
Q

Meds that cause urticaria

A

Bupropion (hepatitis and SSLR), cetirizine and hydrosyzine paradoxically

87
Q

Angioedema

A

Blacks 5x more likely
Lisinopril/enalapril more likely than cap
1 week to months so may develop

88
Q

Children with what dz may suffer potentially fatal macrophage activation syndrome with red men from vancomycin

A

JIA

Red man caused by elevated histamine levels, may see a macular eruption on the neck which spreads

89
Q

Photosensitivity action spectra

A

UVA and visible 315-430)

90
Q

Photo distributed lichenoid rxn

A

Thiazides, quinidine, NSAIDs, diltiazem (marked hyperpig). clopidogrel

91
Q

Voriconazole skin manifestations

A

Photosensitivity (not dose dep like amiodarone), cheilitis, facial erythema, pseudoporphyria with foot erosions also, eruptive nevi and lentigines, SCCs, photodistributed GA

92
Q

Photo distributed telangectasias

A

CCB, cefotaxime

*steroids, OCPs, isotretinoin, IFN, lithium, thiothixene, mtx may induce tel but not through photosensitivity

93
Q

MCC of psudoporphyria

A

Naproxen

  • other nsaids but not pyroxicam, TCN, lasix, isotretinoin/acitretin, 5fu, bumetanide, dapson, OCP, rofecoxib, celecoxib, CSA, voriconazole, pyridoxine dialysis (n acytelcycteine may help)
  • positive DIF like PCT
94
Q

Embolia cutis medicamentosa/ livedoid dermatitis/ Nicolau syndrome

A

Injection site reaction from periarterial injection
Blanching –> macule that evolves into a violations patch with dendrites –> hemorrhagic and ulcerates
Muscle and liver enz may be high
Neurological sequela in 1/3
NSAIDs, steroids, depo, IFN (unrelated agents)

95
Q

SSLR

A

Minocycline, bupropion, rituximab

96
Q

Drug induced ulceration of the lower lip

A

Type of lichenoid rxn

Usually to diuretics

97
Q

Radiation recall

A

Months to yrs following xrt treatment recall rxn with administration of certain chemo drugs, IFN alpha and simvastatin

Similar reactivation of sunburn with mtx can occur

98
Q

Palifermin associated papular eruption

A

Resembles flat warts

99
Q

EGFR cutaneous SE

A

Papulopustular eruption MC - TCN may treat
TNF alpha and IL1 mediate cutaneous rxn
Curly hair and trichomegaly can be seen

100
Q

Pso exacerbation, a real psoriasiform hyperkeratosis, PR-like eruption, periorbital edema (PDGFR inhibition)

A

Imatinib

101
Q

Lobular panniculitis

A

Dasatinib

102
Q

KP like eruption and KAs

Facial/scalp erythema and dysethesia

A

Sorafenib

103
Q

GCSF

A 
Injection site reactions
Sweets (1 week after initiation)
LCV
Necrotizing panniculitis
Granulomatous skin rxns
104
Q

Granulomatous skin reactions

A

GCSF
Anakinra
EPO

105
Q

IL2

A

Diffuse erythema followed by desquamation
Mucositis
Pruritus
Flushing

*administration of iodinated contrast material within 2 weeks of IL2 therapy will cause hypersensitivity in 30% of cases

106
Q

TNF inhibitors

A

Recall injection site reaction - CD8 mediated
PP PSO in 40%
Mechanism of PSO is through TH1 and increases IFN alpha production
Sarcoid
11% of RA pts treated with etanercept develop positive ANAs, 15% dsDNA
Drug induced lupus avg after 41 weeks - compared to other DIL the tnf inh cause more malar rash, discoid lesions, photosensitivity
Vasculitis - vasculitis (p anca and cryoglob may be positive
Lichenoid drug
Sl increased Risk of NMSC’s, especially if on mtx

107
Q

Acrodynia/calomel disease

A

Mercury poisoning in infancy
Painful swelling of the hands/feet with cold/clammy/dusky changes
May see hemorrhagic puncta with blotchy erythema on the trunk
Stomatitis with fever
Albuminuria and hematuria
Dx - Mc in urine

*Mc inhalation may also cause a morbilliform eruption with groin/thigh accentuation like baboon syndrome

108
Q

Bromoderma

A

Coalescent pustules on a raised border at the periphery of a lesion
Excessive soft drink ingestion or meds (dextromethorphan hydrobromide)

109
Q

Iododerma

A

Acneiform eruption

Dermal bullous lesions

110
Q

Drug induced SLE

A

Procainamide, hydralazine, quinidine, captopril, minocycline, INH, carbamazepine, propothiouracil, sulfasalazine, statins

DIL rarely has skin lesions, M=F, mild sx like fever, arthritis, serositis
ANA is positive but not dsDNA, normal C’

111
Q

TNF alpha inhibitor induced lupus

A 
Especially etanercept
Prominent skin lesions
F>M
Nephropathy with CNS involvement may occur
Anti-dsDNA +, hypocomplementemic
112
Q

Drug induced SCLE

A

Days to yrs can occur

Terbinafine, hydrochlorothiazide, diltiazem MC
ACE inh, PPI’s, statins, NSAIDs, plaqinel, leflunomide may also cause

May be ANA + and have antihistone ab but have + SSA

Photosensitive lesions but not photodistributed or annular
Etanercept may also cause SCLE

113
Q

Leukotriene receptor antagonist Churg Strauss syndrome

A

2 d to 10 mo after
Fluticasone inh may also cause
Eosinophilia, pulmonary > neuropathy sinusitis, cardiac
Usually purpuric lesions of the lower legs
LCV with eos
P ANCA maybe positive
May be caused by unopposed B4 activity

114
Q

Injected steroids

A

May migrate along lymphatics and cause linear atrophic hypopigmented hairless streaks

Use TAC acetonide, not hexacetonide

Dermatology (28 decks)

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