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J Derm > Cutaneous drug eruptions > Flashcards

Cutaneous drug eruptions Flashcards

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Dermatology Board Prep flashcards
1
Q

what is a cutaneous drug eruption

A

any adverse reaction to a drug visible on the skin

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2
Q

are they common/uncommon

A

common - occur in 3% of hospital patients

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3
Q

can be allergic or non-allergic, give examples of both

A

allergic/immune mediated/hypersensitivity reaction
type I-IV

non allergic/non immune mediated
eg eczema, phototoxicity, psoriasis, pigmentation

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4
Q

are allergic cutaneous drug reactions dose dependant

A

no

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5
Q

are non allergic cutaneous drug eruptions dose dependant

A

yes

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6
Q

general presentation

A 
dependant on type of reaction!!!
type I - urticaria (5%)
type II - pemphigus, pemphigoid 
type III - rash, purpura 
type IV - rash, erythema (95%)

Sudden onset symmetric skin eruptions

non allergic/non immune mediated
eg photosensitivity, pain, itch, pigmentation, psoriasis, skin erosion

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7
Q

type IV drug hypersensitivity presentation (95% of hypersensitivity reactions)

what is the onset

what is the presentation of a severe reaction

A

RASH!
can be exanthematous (rash) or morbilliform (measles like rash) or macorpapular (rash with small bumps)

onset 4-21 days

severe if - fever, blisters, SOB, involvement of face/mucous membrane

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8
Q

aetiology of type IV drug hypersensitivity (95% of hypersensitivity reactions)

A 
antibiotics - penicillin, sulphonamide, erythromycin, streptomycin
NSAIDs
anti-epileptics 
phenytoin 
allopurinol
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9
Q

type I drug hypersensitivity presentation (5% of hypersensitivity reactions)

A

URTICARIA!

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10
Q

aetiology of type I drug hypersensitivity (5% of hypersensitivity reactions)

A

antibiotics - beta lactam, vancomycin, quinolones
NSAIDs
aspirin
opiates

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11
Q

type II drug hypersensitivity presentation

A

rash and itchy blisters (PHEMPHIGUS/PEMPHIGOID)

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12
Q

aetiology of type II drug hypersensitivity

A

ACE inhibitors
penicillin
furosemide

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13
Q

presentation of a fixed drug reaction

A

location - at site of drug administration only (eg hands, lips, genitalia but NOT in mucosa eg vagina, mouth)

red
painful

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14
Q

how does a fixed drug reaction resolve

A

with persistant pigmentation after removal of drug

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15
Q

what is phototoxic cutaneous drug reactions

A

photosensitivity to sunlight caused by drugs

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16
Q

aetiology of phototoxic cutaneous drug reactions

A

amiodarone, CA channel clockers, antibiotics, NSAIDs, BRAF inhibitors, immunosuppressants, thiazide diuretics

17
Q

presentation of phototoxic cutaneous drug reactions

A

heat prickling
exaggerated sunburn
increased skin fragility

all in response to UVA/visible light

18
Q

what are the investigations conducted if a cutaneous drug eruption is suspected

A 
history and examination usually suffice 
phototesting 
patch test (if type IV suspected) 
skin prick (if type I suspected) 
NOT skin testing
19
Q

general treatment of cutaneous drug reactions

A 
removal of drug 
find alternative drug 
antihistamines 
topical steroids 
REPORT via yellow card scheme
20
Q

complications of cutaneous drug reactions (if untreated)

A

steven Johnson syndrome (SJS)
toxic epidermal necrolysis (TEN)
drug reaction with eosinophilia and systemic symptoms (DRESS)
acute generalised exanthematous pustulosis (AGEP)

21
Q

how does steven Johnson syndrome (SJS - a complication of cutaneous drug reaction) present (7)

A

flu like symptoms
fever
blistering, peeling (like TEN but <10% of skin)
eye problems - conjunctivitis, occlusion of lacrimal glands, corneal ulcer

22
Q

what does TEN (a complication of cutaneous drug reaction) stand for

how does TEN present

A

toxic epidermal skin necrolysis

SKIN FAILURE
flu like symptoms, mouth erosions, generalised erythema, fever, blistering, peeling (like SJS but >30% of skin)

23
Q

what are the complication of TEN

A

sepsis
organ failure
pneumonia

24
Q

what is the prognosis of TEN

A

50% survival

25
Q

what does DRESS (a complication of cutaneous drug reaction) stand for

how does DRESS present

A

drug reaction with eosinophilia and systemic symptoms

inflammation, rash, fever, lymphadenopathy

26
Q

what does AGEP (a complication of cutaneous drug reaction) stand for

how does AGEP present

A

acute generalised exanthematous pustulosis

pustular rash
can be life threatening

27
Q

what causes pityriasis rosea

A

viral infection

28
Q

how does pityriasis rosea present

A

herald patch - single red and scaly area

then pink whole body rash

29
Q

how is pityriasis rosea treated

A

self limiting, goes after 3 months

30
Q

which skin infection is a ‘herald patch’ associated with

A

pityriasis rosea

J Derm (23 decks)

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