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Dermatology > Cutaneous Drug eruptions > Flashcards

Cutaneous Drug eruptions Flashcards

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Dermatology Board Prep flashcards
1
Q

What kind of reactions are pemphigus and pemphigoid?

A

Type II

Cytotoxic reactions

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2
Q

What would you see in a type I immune reaction?

A

Urticaria

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3
Q

What would you see in a type III immune reaction?

A

Pupura/rash

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4
Q

What would you see in a type IV immune reaction?

A

erythema/rash

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5
Q

What are the risk factors for drug eruptions?

A 
Age
Gender
Genetics 
Concomitant disease
Immune status
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6
Q

Which age groups are more likely to get drug eruptions?

A

young adults > infants/elderly

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7
Q

What gender are more likely to get drug eruptions?

A

Females

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8
Q

Which concomitant diseases raise the chance of getting a drug eruption?

A

Viral infection (HIV/EBV/CMV)

Cystic fibrosis

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9
Q

What are the risk factors for drugs involved in eruptions?

A

Chemistry
Route
Dose
Kinetics/half life

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10
Q

What drugs Chemistry makes them likely to cause an eruption?

A

B lactic compounds, NSAIDs

High molecular weight, hapten forming drugs

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11
Q

What is the most common type of drug eruption?

A

Exanthematous drug eruption

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12
Q

What kind of reaction is an exanthematous drug eruption?

A

idiosyncratic, T-cell mediated delayed type hypersensitivity (IV) reaction

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13
Q

What is seen in an Exanthematous drug eruption?

A

Widespread, symmetrically distributed rash,

itch is common, mucous membranes spared

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14
Q

How quick is onset of an exanthematous drug eruption?

A

4-21 days after onset of drug

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15
Q

What is the danger with exanthematous drug eruptions?

A

It can progress to a severe life threatening reaction

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16
Q

What would indicate a potentially severe exanthematous drug eruption?

A
  • Involvement of the mucous membranes and the face
  • facial erythema and oedema
  • widespread confluent erythema
  • fever >38.5
  • skin pain
  • blisters, purpura, necrosis
  • lymphadenopathy, arthralgia
  • SOB, wheezing
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17
Q

What drugs are associated with exanthematous eruptions?

A
  • Penicillins
  • Sulphonamides
  • erythromycin
  • allopurinol
  • anti-epileptics; carbamazepine, phenytoin
  • NSAIDs
  • chloramphenicol
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18
Q

What are the two mechanisms of urticarial drug reactions?

A

Usually IgE mediated type I after rechallenge with drug
OR
Direct release of inflammatory mediators from mast cells on first exposure

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19
Q

Which drugs cause urticarial drug reactions by direct release of inflammatory mediators from mast cells?

A 
Aspirin
Opiates
NSAIDs
Muscle Relaxants
Vancomycin
Quinolones
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20
Q

What may urticarial reactions be associated with?

A

Angioedema or anaphylaxis

21
Q

Which drugs cause acneiform drug reactions?

A

Glucocorticoids

Androgens, lithium, isoniazid, phenytoin

22
Q

Which drugs cause generalised exanthematous pustulosis (AGEP)

A

Antibiotics, CCB, antimalarials

23
Q

What drugs can induce bullous pemphigoid?

A

ACE inhibitors, penicillin, furosemide

24
Q

What drug can trigger linear IgA disease?

A

Vancomycin

25
Q

What is seen in a fixed drug eruption?

A

Well demarcated round/ovoid plaques

Red, hands, genitalia, lips, occasionally oral mucosa

Can present as eczematous lesions, papule, vesicles or urticaria

26
Q

How do fixed drug eruptions resolve?

A

Persistent pigmentation when drug stopped

27
Q

What is significant about fixed drug eruptions?

A

Can re-occur at same site on re-exposure to drug

28
Q

What drugs are associated with fixed drug eruptions?

A

Tetracycline, doxycycline

Paracetamol

NSAIDs

Carbamazepine

29
Q

Name some severe cutaneous adverse drug reactions?

A

Stevens-johnson syndrome (SJS)

Toxic epidermal necrolysis (TEN)

Drug reaction with eosinophilia and systemic symptoms (DRESS)

Acute generalised exanthematous pustulosis (AGEP)

30
Q

What drugs can cause SJS or TEN?

A

Sulfonamides, cephalosporins, carbamazepine, phenytoin, NSAIDs, nevi rapine, lamotrigine, setraline, pantoprazole, tramadol

31
Q

What drugs can cause DRESS?

A

Sulfonamides, anticonvulsants, allopurinol, minocycline, dapsone, NSAIDs, abacavir, nevirapine, vancomycin

32
Q

What are the acute phototoxic drug reactions?

A

Skin toxicity- photosensitivity

Systemic toxicity

Photodegradation

33
Q

What are the chronic phytotoxic drug reactions?

A

Pigmentation

Photoageing

Photocarcinogenesis

34
Q

What is the mechanism of phytotoxic cutaneous drug eruptions?

A

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

35
Q

What usually causes phototoxic cutaneous drug reactions?

A

Usually UVA/visible light eg. through window glass

36
Q

What other mechanisms aside from drug use can cause increased sensitivity to sunlight?

A

Immunosuppression

Lupus

37
Q

What drugs present with immediate prickling with delayed erythema and pigmentation?

A

Chlorpromazine

Amiodarone

38
Q

What drugs present with exaggerated sunburn?

A

Quinine

Thiazides

Demeclocycline

39
Q

What drugs present with exposed telangectasis?

A

Calcium channel antagonists

40
Q

What drugs present with delayed 3-5 days erythema and pigmentation?

A

Psoralens

41
Q

What drugs present with increased skin fragility?

A

Naldixic acid, tetracycline naproxen, amiodarone

42
Q

What drugs are common culprits of photosensitivity?

A

Doxycycline
Amiodarone
Chlorpromazine
Quinine

43
Q

What does PPI induced photosensitivity present as?

A

Sub-acute cutaneous lupus

44
Q

What is photo testing done for?

A

suspected phototoxic drug reactions

45
Q

What are biopsies taken for

A

identifying the type of drug reaction and exclusion of other diseases

46
Q

What are patch and photo patch tests used for?

A

suspected allergic contact dermatitis (type IV)

47
Q

What are skin prick/intradermal tests for specific drugs useful for?

A

Suspected allergic reactions (Type I)

48
Q

What is skin testing not indicated for?

A

Serum sickness reactions (type III) or for cell mediated (type IV) reactions or for those with severe cutaneous adverse drug reactions

49
Q

What are the best management options?

A
  • Discontinue drug and use alternative
  • Topical corticosteroids
  • antihistamies if type I ot itch
  • use of allergy bracelet

Dermatology (15 decks)

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