Desquamation & Drug Eruptions

Question 1

drug eruption that occurs in the 2nd week of medication use; causes as exanthem without systemic reaction

Answer 1

simple drug eruption

Question 2

drug eruption that involves systemic reaction and lab changes

Answer 2

complex drug eruptions

Question 3

what medications commonly cause drug eruptions?

Answer 3

antibiotics

Question 4

a patient presents with this rash without systemic symptoms. what is the diagnosis and treatment?

Answer 4

simple drug eruption

D/C drug
diphenhydramine

Question 5

a patient presents with this rash and has systemic symptoms. what is the diagnosis?

Answer 5

complex drug eruption

Question 6

a patient presents with this erythematous maculopapular rash that becomes confluent. what is the likely offending agent and diagnosis?

Answer 6

ampicillin

simple drug eruption

Question 7

a patient presents with this acne. what is the likely offending agent and diagnosis?

Answer 7

steroid

simple drug eruption

Question 8

a patient presents with this rough, papular rash that is erythematous. what is the likely offending agent and diagnosis?

Answer 8

amoxicillin

simple drug eruption

Question 9

a patient presents with these targetoid lesions that developed over 10 days. it is bilateral and symmetrical + vesicles. what is the diagnosis and treatment?

Answer 9

herpes-associated erythema multiforme (MINOR)

oral acyclovir, valaciclovir, famciclovir
supportive treatment

Question 10

what is the difference between major and minor erythema mulitforme?

Answer 10

major involves mucous membranes

Question 11

what is the most common cause of major erythema multiforme?

Answer 11

medication

Question 12

a patient presents with targetoid lesions on the lips that became confluent with bullae. patient has fever and fatigue. what is the diagnosis and treatment?

Answer 12

major erythema multiforme

oral, IM, IV systemic steroids
supportive treatment

Question 13

in a patient with this skin lesion, discontinuing the offending medication should be done before what, to improve clinical outcome?

Answer 13

before bullae form

Question 14

acute life threatening mucocutaneous reactions with extensive necrosis and erosion of the epidermis (2)

Answer 14

stevens-johnson syndrome
toxic epidermal necrolysis

Question 15

what are 2 drugs that can cause stevens-johnson syndrome & toxic epidermal necrolysis?

Answer 15

trime-sulfa (bactrim)
anti-epileptics

Question 16

mucocutaneous reaction with <10% epidermal detachment

Answer 16

stevens-johnson syndrome

Question 17

mucocutaneous reaction with >30% epidermal detachment

Answer 17

toxic epidermal necrolysis

Question 18

how long do stevens-johnson syndrome & toxic epidermal necrolysis take to erupt from 1st exposure to onset?

Answer 18

1-3 weeks

Question 19

a patient presents with history of fever, malaise, arthralgias, and conjunctival burning/itching. 3 days later, they have skin pain, skin tenderness with paresthesias, erythematous skin lesions with erosions and + nikolsky sign. what is the diagnosis and treatment (4)?

Answer 19

stevens-johnson syndrome & toxic epidermal necrolysis

ICU or transfer to burn center
IV hydration
systemic steroids + cyclosporine
IV immunoglobulin

Question 20

what should we watch out for in patients with stevens-johnson syndrome & toxic epidermal necrolysis?

Answer 20

sepsis

Question 21

a patient presents with these skin lesions. what is the diagnosis and treatment (4)?

Answer 21

stevens-johnson syndrome & toxic epidermal necrolysis

ICU/burn center
IV hydration
systemic steroids + cyclosporine
IV immunoglobulins

Question 22

diagnosis and treatment

Answer 22

stevens-johnson syndrome & toxic epidermal necrolysis

ICU/burn center
IV hydration
systemic steroids/cyclosporine
IV immunoglobulin