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Dermatology > Cutaneous drug eruptions > Flashcards

Cutaneous drug eruptions Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the different types of cutaneous reactions associated with hypersensitivity reactions?

A

Type 1 - urticaria
Type 2 - pemphigus and pemphigoid
Type 3 - pupura (non-blanching) / rash
Type 4 - erythema, rash, dermatitis

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2
Q

Are hypersensitivity reactions dose-dependent?

A

No

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3
Q

What are the different types of non-immunological cutaneous reactions?

A 
Eczema
Drug-induced alopecia
Phototoxicity 
Skin erosion 
Atrophy due to topical corticosteroids 
Psoriasis 
Pigmentation 
Cheilitis, exrosis
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4
Q

What are the morphologies of cutanous drug eruptions?

A 
Exanthematous/ morbiliform/ maculopapular 
Urticarial
Papulosquamous/ pustular/ bullous
Pigmentation
Itch/ pain
Photosensitivity
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5
Q

With what distribution of rash should make you think of a cutaneous drug eruption?

A

Symmetrical, widespread rash

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6
Q

What are some risk factors for drug eruptions?

A

Female
Elderly
Genetics - polymorphisms that handle drug metabolism will indiate susceptibility to drug reactions
Concomitant disease; immunosuppression, viral infections (HIV/ EBV/ CMG), CF
Immune status; previous drug reractions or positive skin test
Chemisty
Route
Dose
Kinestics/ half-life

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7
Q

What type of chemical components of drugs will make them more likely to cause drug eruptions?

A

Beta lactam compounds
NSAIDs
High molecular weight/ haptne-forming drugs

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8
Q

What is a hapten?

A

A small molecule which, when combined with a larger carrier such as a protein, can elicit the production of antibodies which bind specifically to it

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9
Q

What should be considered on a patient on multiple drugs?

A

What is the drug most likely to cause an eruption?
Time interval between exposure and development of skin reaction
History of previous exposure to the same drug

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10
Q

What is an exanthematous drug eruption?

A 
Most common type of drug eruption 
Idiosyncratic, T-cell mediated delayed type 4 hypersensitivity 
Mild and self-limiting 
Widespread symetrically distributed rash 
Mucous membrane spared
Itch 
MILD fever 
4-21 day onset after drug ingestion
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11
Q

What are the indicators of a potentionally severe drug eruption?

A 
Involvement of mucous membrane and face
Facial erythema and oedema
Widespread confluent erythema
Fever (>38.5)
Skin pain
Blisters, purpura, necrosis
Lymphadenopathy, arthralgia
SOB, wheezing
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12
Q

What drugs are associated with exanthematous eruptions?

A 
Penicillins
Sulphonamides
Erythmocyin
Streptomycin
Allopurinol
Anti-epileptics (carbamazepine, phenytoin)
NSAIDs
Chloamphenicol
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13
Q

What drugs can cause a direct release of inflammatory mediators from mast cells on first exposure?

A 
Aspirin
Opiates
NSAIDs
Muscle relaxants
Vancomycin
Quinolones
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14
Q

How would you describe an urticarial reaction?

A

Dermal oedema casing a blanching, erythematous wheal

Spontanous, lesions should disappear within 24 hours

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15
Q

What is it called when an urticarial rash lasts for longer than 24 hours?

A

Urticarial vasculitis

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16
Q

What are the 2 types of pustular or bullous drug eruptions?

A

Acneiform

Acute generalised exanthematous pusulosis (AGEP)

17
Q

What can cause aacneiform?

A

Glucorticoids

Androgens, lithium, isoniazid, phenytoin

18
Q

What can cause AGEP?

A

Antibiotics
CCB (amlodipine)
Antimalarials

19
Q

What is the difference between acne vulgaris and acneiform?

A

Acneiform doesn’t have comedones or greasiness

Only pustules

20
Q

What drugs can cause drug-induced bullous pemphigoid?

A

ACEI
Penicillin
Furosemide

21
Q

What drug eruption can vancomycin cause?

A

Ring shaped blistering rash with linear deposits of IgA

Can also cause red man syndrome

22
Q

What is a fixed drug eruption?

A

Well demarcated round plaques

Erythematous and painful

23
Q

Where can fixed drug eruptions be found?

A 
Hands
Genetalia
Lips
Oral mucosa
Buttocks
24
Q

What drugs are associated with fixed drug eruptions?

A

Tetraycline, doxycycline
Paracetamol
NSAIDs
Carbamazepine

25
Q

What are the different types of severe cutaneous adverse drug reactions?

A

Stevens-johnson syndrome (SJS)
Toxic epidermal necrolysis (TEN)
Drug reaction with eosinophilia and systemic symptoms (DRESS)
Acute generralised exanthematous pustolosis (AGEP)

26
Q

What drugs are associated with SJS and TEN?

A 
Sulfonamides 
Cephalosporins
Carbamazepine
Phenytoin
NSAIDs
Nevirapine
Lamotrigine
Sertraline
Pantoprazole
Tramadol
27
Q

What are acute phototoxic drug reactions?

A

Skin toxicity - photosensitivity
Systemic toxicity
Photodegradation

28
Q

What are chronic phototoxic drug reactions?

A

Pigmentation
Photoageing
Photocarcinogenesis

29
Q

What is a phototoxic cutaneous drug reaction?

A

Non-immunological skin reaction arising in an individual exposed to enough photo-reactive drug and light of the appropriate wavelengths

30
Q

What wavelength of light usually causes a phototoxic cutaneous drug reaction?

A

UVA and visible light

31
Q

What are patterns of phototoxicity?

A

Immediate prickling with delayed erythema and pigmentation
Exaggerated sunburn
Exposed tenalgiectasia
Delayed 3-5 days erythema and pigmentation
Increased skin fragility

32
Q

What drugs are associated with phototoxicity?

A 
Antibiotics - flurorquinolones
Thiazides
NSAIDs
Amiodarone 
Porphyrins
33
Q

How can drug eruptions be investigated?

A 
History 
Phototesting
Biopsies
Patch test (type 4) 
Skin prick (type 1)
34
Q

How can drug eruptions be managed?

A

Avoid drug
Topical corticosteroids
Antihistamines
Drug adverse effects reported via yellow card scheme

Dermatology (24 decks)

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