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Dermatology > Cutaneous drug eruptions > Flashcards

Cutaneous drug eruptions Flashcards

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Dermatology Board Prep flashcards
1
Q

Urticaria

A

Type 1 anaphylactic reaction

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2
Q

Pemphigus and pemphigoid

A

Type II cytotoxic reaction

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3
Q

Purpura/rash

A

Type III immune complex mediated reaction

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4
Q

T-cell mediated erythema/ rash

A

Type IV cell mediated delayed hypersensitivity reaction

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5
Q

Are immunologically mediated reactions dose dependent?

A

No

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6
Q

Eczema immunologically mediated?

A

No

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7
Q

Are eczema, drug induced alopecia, phototoxicity, skin erosion/atrophy (from topically applied 5FU/steroids), Psoriasis, pigmentation, cheilitis, xerosis dose dependent?

A

Yes, because these are not immunologically mediated

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8
Q

Concommittent disease that may make you more likely to have drug eruption?

A 
Viral infections (HIV/EBV/CMV)
Cystic fibrosis
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9
Q

Why can NSAIDs cause reaction?

A

They have beta lactam ring –> this is a risk

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10
Q

Most common type of drug eruption?

A

Xanthematous drug reaction

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11
Q

What type of hypersensitivity is a xanthematous drug reaction?

A

Type IV (T cell mediated)

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12
Q

When would you get xanthematous reaction?

A

4-21 days after taking first drug

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13
Q

Pattern of xanthematous drug reaction distribution?

A

Wide spread, symmetrically distributed
Mucous membranes usually spared

Itch is common
Fever is common

(can progress to severe)

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14
Q

Indicators of a potential severe reaction? (xanthematous)

A 
Involvement of mucous membrane and face. • Facial oedema & erythema.
• Widespread confluent erythema.
• Fever (>38.50C).
• Blisters, purpura, necrosis.
• Lymphoadenopathy, arthalgia.
• Shortness of breath, wheezing.
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15
Q

PECANS SAP

xanthematous reaction

A 
Penicillins
Erythromiciin
Chloramphenicol
Allopurinol
NSAIDS
Sulfonamide abx

Streptomicin
Anti-epileptics
Phenytoin

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16
Q

Urticaria usually mediated by which Ig?

A

IgE

IgE

Usually an immediate IgE- mediated hypersensitivity reaction (Type I) after rechallenge with drug (β-lactam antibiotics, carbazepine, many other drugs).
Or
– Direct release of inflammatory mediators from Mast cells on first exposure (aspirin, opiates, NSAIDs, muscle relaxants, vancomycin, quinolones)

17
Q

Drugs which could cause acne?

PAILS

A 
Phenytoin
Androgens
Isoniazid
Lithium
Steroids
18
Q

Drugs which could cause acute generalised exanthematous pustulosis? (AGEP)
(CAbAm)

A

Calcium channel blockers
Antibiotics
Antimalarials

19
Q

Drug induced bullous pemphigoid?

FAP …. lol

A

Furosemide
ACE inhibitors
Penicillin

20
Q

Drug which could trigger linear IgA disease?

A

Vancomycin

21
Q

Describe a fixed drug eruption appearance?

A

Well demarcated, round/ovoid plaque
Red, painful

Hands, genitalia, lips, occasionally oral mucose

22
Q

Will a fixed drug eruption resolve when you stop taking that drug?

A

Yes but you have persistent pigmentation

-can reoccur on the same site on re-exposure to the drug

23
Q

Drugs associated with fixed drug eruptions?

Try Doing Nothing Cause Paracetemol

A 
Tetracylcine
Doxycyline
NSAIDS
Carbamazepine
Paracetemol
24
Q

Drugs which would cause SJS/TEN

Suck Candy Cause Nobody Pays Today

A 
Sulfonamide
Cephalosporins
Carbamezepine
NSAIDs
Phenytoin
Tramadol
25
Q

Drug reaction with eosinophilia and systemic symtpoms?

(VAANS

A 
Vancomycin
Allopurinol
Anti-convulsants
NSAIDs
Sulfonamides
26
Q

Are phototoxic cutaneous drug reactions immunologically mediated?

A

No, they will arise in anyone if there is enough appropriate drug and the appropriate wavelength of light

27
Q

Waveband of light that usually causes phototoxic drug reaction?

A

UVA/visible light

Can occur indoors through window and glass

28
Q

When you react to psoralen, when would you develop erythema and pigmentation?

A

3-5 days after

29
Q

Which drugs will exxagerate sunburn? (QT)

A

Qunine, thiazides

30
Q

Which drugs will give you telangiectasia in the sun? (CT)

A

Calcium channel blockers cause Telangiectasia

31
Q

Immediate prickling with delayed erythema and pigmentation?

A

Chlorpromazine, amiodarone

32
Q

Why is skin testing NOT indicated for serum sickness reactions (TYPE III) or for T-cell mediated reactions (TYPE IV)?

A

Can potentially trigger SJS, TEN and DRESS

33
Q

Test if you think it is a suspected allergic contact dermatitis (type IV)?

A

Patch and photopatch test

34
Q

Management of cutaneous drug reaction?

A

Discontinue the drug (if possible). Use an alternative.
• Topical steroids may be useful.
• Antihistamines may be useful.
• Allergy bracelets are useful for some drugs.
• Drug eruptions should be reported via the Yellow Card scheme (Medicines and Healthcare products Regulatory Agency)

Dermatology (27 decks)

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