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Medicine 2 > Cutaneous Adverse Drug Rxns & Cutaneous Carcinoma > Flashcards

Cutaneous Adverse Drug Rxns & Cutaneous Carcinoma Flashcards

1
Q

What are the 4 main catgories of Cutaneous drug reactions?

A

Exanthematous/Morbilliform
Urticartial
Fluid-filled lesions/Blistering
Pustular

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2
Q

What are causes of non-immunologic CADRS?

A

Idiosyncrasy
Cumulation
Pharmacologic adverse event
Induction or exacerbation of a disease
Cumulative toxicity

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3
Q

What can CADR can be exacerbated due to chronic intake of oral steroids?

A

Pustular psoriasis

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4
Q

What is a CADR of Isoniazid?

A

Isoniazid-induced acne

(Used to tx pumonary TB)

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5
Q

What is a CADR of Clofazimine?

A

Clofazimine-induced hyperpigmentation

(Tx for leprosy; slate gray hyperpigmentation on the face & trunk)

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6
Q

What is a CADR of taking HIV drugs?

A

Lipodystrophy

(Loss of fat in the cheeks)

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7
Q

What are the 2 classifications of CADRS?

A

Imemdiate reactions
Delayed reactions

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8
Q

How to do you classify CADR as an immediate reaction?

A

Within 6 hrs or occurs within 30 mins from lat administered dose

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9
Q

How do you classify it as a delayed reaction of CADRS?

A

> 6 hours and occassionally weeks to months after start of administration

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10
Q

What is our approach to patients with CADRS?

A

“RASH”
Remember
Appearance
Systemic featuers
Histology

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11
Q

What are the lab tests ordered for CADRS?

A

CBC
Drug testing (if assoc with overdosage)
Liver & Kidney FTs

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12
Q

What is the preferred method of evaluation of possible type 1 IgE-mediated penicillin allergy

A

Penicillin skint test

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13
Q

What are the 2 types of localized CADRs?

A

Fixed drug eruptions
Irritant/allergic contact dermatitis

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14
Q

What type of localized CADR presents as erythmetaous or violaceous slitary macule, patch, or plaque that recurs at the same site?

A

Fixed drug eruptions

(Develops 30mins-8hrs after drug intake)

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15
Q

What are medications that cause fixed drug eruptions (FDE)?

A

Tetracycline
Metronidazole
Sulfonamides
NSAIDs

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16
Q

What are the management options for FDR?

A

Drug withdrawal
Topical steroids
Pain meds, wound care
Topical antibiotics if eroded

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17
Q

What is the diff betw irritant contact dermatitis & allergic contact dermatitis?

A

Irrirtant contact dermatitis = well-demarcated & localized areas of thin skin

Allergic contact deramtitis = linear or angular lesion

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18
Q

What are the common irrirtans causing irritant CD?

A

Chronic wet work
Soaps
Detergents

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19
Q

What aer the 5 generalized cutaneous ADRs?

A

Urticaria/angioedema
Exanthematou Morbilliform drug eruption
Drug-induced hypersensitivity syndrome
Acute generalized exanthematous pusulosis
Steven johnsons syndrome & Toxic epidermal necrolysis

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20
Q

What are common causes of Urticaria/Angioedema CDRs?

A

Drugs: ACE inhibitors, penicillin, NSAID, opiates, conrtast dyes

Blood products
Idiopathic

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21
Q

What are DOC for urticaria CDR?

A

Antihistamines

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22
Q

What is the management of angioedema CDR?

A

IV antihistamine or epinephrine
Steroids

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23
Q

What is the most common type of cutaneous drug rxn that appears 4-14 days after intake of drug?

A

Exanthematou/morbilliform drug eruption

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24
Q

What are the common meds that cause Exanethamatous drug eruption (EDE)?

A

Penicillin
Cephalosporin
Sulfonamides
NSAIDs
Anticonvulsants

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25
Q

What are the clinical manifesation of drug-induced hypersensitivity syndrome (DIHS)?

A

Systemic symptoms
Lymphadenopathy
Rash
Systemic & organ involvement

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26
Q

What are the common meds causing DIHS?

A

Allopurinol
Antibiotics
Anticonvulsants
Isoniazid
NSAID

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27
Q

What generalized cutaneou ADR has small non-follicular pustules on an erythematous based on the trunk & extremities?

A

Acute generalized exanthematous pusulosis

(Appears 48 hrs after drug intake)

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28
Q

What are the clinical manifestations of AGEP?

A
  • fever, malaise, lymphadenopathy, & abrupt pustular lesions
  • systemic involvement in 20% of the patients (hepatocellular dysfunction & nephritis)
29
Q

What is a dermatologic emergency that presents with acute life-threatening mucocutaneou rxns?

A

Steven johnson syndrome (SJS) or
Toxic epidermal necrolysis (TEN)

30
Q

What are the common causes of SJS & TEN?

A

Viral infection OR Mycoplasma

31
Q

What are the clin manifestations of SJS/TEN?

A

(+/-) Prodromal symptoms: Fever, sore throat
Tender, erythematous skin or mucosa
Detachment of epidermis, cutaneou & mucosal exfoliation
(+/-) multisystemic involvemenet: bronchitis, GIT ulcers, hepatitis, nephritis

32
Q

What aer the course of clinical presentation?

A

Prodrome: fever, malaise, cough, headache
1-3 days before skin eruption: mucosal involvement
1-4 weeks: erythema & skin tenderness
Vesicles & bullae
Erosions and exfoliation

33
Q

What are the common medications that cause SJS/TEN?

A

“SANTAN”
Sulfonamides
Allopurinole
NSAIDs
Tetracyclines
Anticonvulsants
Nevirapine

34
Q

What are atnihistamines given in cutaneou DRs?

A

1st gen H1 antihistamines = sedating
2nd gen H1 antihistamines = less sedating

35
Q

Is there tx required in benign cutaneou tumors?

A

No

36
Q

What are the management options for benign cutaneou tumros?

A

Electrodessication & curettage
CO2 laser
Cryotherapy
Excision

37
Q

What are the diff Benign Cutaneous Tumors?

A

Sebaceous gland hyperplasia
Milium
Syringoma
Common acquired melanocytic nevi
Seborrheic keratosis
Keratocanthoma

38
Q

What is the more common benign cutaneous lesions found in px with oil skin and presents with yellowish, flesh-colored smooth appules with a central umbilication or dell?

A

Sebaceous gland hyperplasia

(Found @ the forehead)

39
Q

What is the clin feature of Milium?

A

1-2mm white to yellowish dome-shaped papules found at the eyelids & cheeks

40
Q

What is the cause of Milium?

A

Eccrine duct plugging

41
Q

What benign CDR is characterized by prolifeation of eccrine glands?

A

Syringoma
(Tadpole-shaped strutures in the deep dermis)

42
Q

What are the clin features of Syringoma?

A

Firm, smooth, skin-colored or slightly yellowish papules to plaques on the lwoer eyelids

(Parang teardrops yung pattern niya)

43
Q

What are collection of nevus cells and appears neat & symmetric, orderly or uniform with regular borders?

A

Common acquired melanocytic nevi

44
Q

What aer the diff types of nevus?

A

Junctional nevus
Compound nevus
Intradermal nevus

45
Q

What are the appearances of the diff types of nevus?

A

Junctional nevus = flat, hyperpigmented macule
Compound nevus = tan, brown hyperpigmented papule or nodule

Intradermal nevus = skin-brown colored papule or nodule

46
Q

What is the most common benign epidermal tumor?

A

Seborrheic keratosis

47
Q

What are the clin features of seborrheic keratosis?

A
  • “stuck on” appearance
  • palms & soles
  • Leser-Trelat sign
48
Q

What are the variants of Seborrheic keratosis?

A

Dermatosis papulosa nigra = found on thef ace
Acrochordon = skin tags (neck, armpit)

49
Q

What are etiologic factors of Keratoacanthoma?

A
  • chronic UV light exposure
  • chemical carcinogens
  • smoking
    -trauma
  • Immunosuppression
50
Q

what are the clin featuers of Keratoacanthoma?

A

Solitary tumor that rapidly grows within a few wks

51
Q

What are the diff management of Keroacanthoma?

A

1st line = complelte surgical excision

52
Q

What are the systemic associations of Keratoacanthoma?

A

Muir-Torre syndrome
Hereditary nonpolyposis colorectal cancer syndrome
Xeroderma pigmentosum
Lymphomatoid papulosso

53
Q

What are the diff malignant cutaneou carcinomas?

A

Squamous cell carcinoma
Basa cell carcinoma
Cutaneous melanoma

54
Q

What are the dx tests of malignant cutaneous carcinomas?

A

Dermoscopy
Punch biopsy - gold std for skin cancer

55
Q

What are causes of SCC?

A

Bruns or long-term heat exposure
Chronic scarring/inflammatory dermatoses

56
Q

What are the clin features of SCC?

A

Solitary firm, flesh-colored or erythematous keratotic plaque or tumor

57
Q

What are the diff management of SCC?

A

Non-excisional ablative therapy
Conventional surgical excision
MOH surgery

58
Q

When do you use MOHS surgery?

A

If cutaneous carcinoma is at the high-risk mask area

59
Q

When do you use conventional surgical excision in SCC?

A

Low risk SCC with a depth of <2mm

60
Q

What gene causes BCC?

A

PTCH gene mutation

61
Q

What aer the diff subtypes of BCC?

A

Superficial BCC
Nodular BCC
Pigmented BCC
Morpheaform BCC

62
Q

What are the clin featuers of BCC subtypes?

A

Nodular BCC (most common) = translucent, telangiectasia

Pigmented BCC = hyperpigmented, translucent or blackish plaque or papule

63
Q

What are the management options for BCC?

A

1st = surgical removal

64
Q

What is a highly aggressive malignant melanocytic tumor?

A

Cutaneous melanoma

65
Q

What are the diff cutaneous melanoma??

A

Superficial spreading melanoma
Nodular melanma
Nevoid melanoma

66
Q

What is the most common cutaneous melanoma w/ Erythemaous or pigmented plaque, bluish brown or skin-colored foudn at the back & LE?

A

Superficial spreading melanoma

67
Q

What are the ABCDE assessment for skin?

A

Asymmetry
Border
Color
Diameter (>5mm)
Evolving

68
Q

What type of cutaneous melanoma is uniformly dark blue-black or bluid red nodule, vertical growth & site is at the trunk?

A

Nodular melanoma

69
Q

What is an important sign of cutaneous melanoma?

A

“Ugly duckling” sign = lesions diff from the rest of lesion or moles

Medicine 2 (13 decks)

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