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4th year passmedicine by topic > Drug Eruptions > Flashcards

Drug Eruptions Flashcards

1
Q

What is Stevens-Johnson syndrome?

A

severe systemic reaction affecting the skin and mucosa that is almost always caused by a drug reaction.

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2
Q

Features of SJS?

A

rash is typically maculopapular with target lesions being characteristic. May develop into vesicles or bullae
mucosal involvement
systemic symptoms: fever, arthralgia

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3
Q

Causes of SJS?

A 
penicillin
sulphonamides
lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill
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4
Q

Mx SJS?

A

hospital admission is required for supportive treatment

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5
Q

What is Toxic epidermal necrolysis?

A

Toxic epidermal necrolysis (TEN) is a potentially life-threatening skin disorder that is most commonly seen secondary to a drug reaction. In this condition, the skin develops a scalded appearance over an extensive area.

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6
Q

What is a +ve Niklosky’s sign?

A

epidermis separates with mild lateral pressure

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7
Q

Features of TEN

A

systemically unwell e.g. pyrexia, tachycardic

positive Nikolsky’s sign

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8
Q

Drugs known to induce TEN

A 
phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs
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9
Q

Mx TEN?

A

stop precipitating factor
supportive care
often in an intensive care unit
volume loss and electrolyte derangement are potential complications
intravenous immunoglobulin has been shown to be effective and is now commonly used first-line
other treatment options include: immunosuppressive agents (ciclosporin and cyclophosphamide), plasmapheresis

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10
Q

What is acanthosis nigricans?

A

Describes symmetrical, brown, velvety plaques that are often found on the neck, axilla and groin.

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11
Q

Drugs causes of acanthosis nigricans?

A

combined oral contraceptive pill

nicotinic acid

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12
Q

causes of acanthosis nigricans?

A 
type 2 diabetes mellitus
gastrointestinal cancer
obesity
polycystic ovarian syndrome
acromegaly
Cushing's disease
hypothyroidism
familial
Prader-Willi syndrome
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13
Q

pathophysiology of acanthosis nigricans?

A

insulin resistance → hyperinsulinemia → stimulation of keratinocytes and dermal fibroblast proliferation via interaction with insulin-like growth factor receptor-1 (IGFR1)

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14
Q

Erythema ab igne is a skin disorder caused by

A

over exposure to infrared radiation.

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15
Q

Erythema ab igne, Characteristic features include

A

reticulated, erythematous patches with hyperpigmentation and telangiectasia.

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16
Q

Erythema ab igne, typical history

A

an elderly women who always sits next to an open fire.

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17
Q

Erythema ab igne is self limiting

A

false

If the cause is not treated then patients may go on to develop squamous cell skin cancer.

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18
Q

What is erythema multiforme?

A

Erythema multiforme is a hypersensitivity reaction which is most commonly triggered by infections

It may be divided into minor and major forms.

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19
Q

Features of erythema multiforme

A

target lesions
initially seen on the back of the hands / feet before spreading to the torso
upper limbs are more commonly affected than the lower limbs
pruritus is occasionally seen and is usually mild

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20
Q

Causes of erythema multiforme

A 
viruses
idiopathic
bacteria
drugs
connective tissue disease e.g. Systemic lupus erythematosus
sarcoidosis
malignancy
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21
Q

Viruses & bacteria that cause erythema multiforme

A

viruses: herpes simplex virus (the most common cause), Orf is a skin disease of sheep and goats caused by a parapox virus
bacteria: Mycoplasma, Streptococcus

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22
Q

Drugs that cause erythema multiforme?

A

penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine

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23
Q

The more severe form, erythema multiforme major is associated with

A

mucosal involvement.

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24
Q

Describe Erythema nodosum

A

inflammation of subcutaneous fat
typically causes tender, erythematous, nodular lesions
usually occurs over shins, may also occur elsewhere (e.g. forearms, thighs)
lesions heal without scarring

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25
Q

Erythema nodosum resolves within

A

usually resolves within 6 weeks

26
Q

Causes Erythema nodosum

A 
infection
systemic disease:sarcoidosis, inflammatory bowel disease, Behcet's
malignancy/lymphoma
drugs
pregnancy
27
Q

Erythema nodosum drugs?

A

penicillins
sulphonamides
combined oral contraceptive pill

28
Q

Erythema nodosum infection?

A

streptococci
tuberculosis
brucellosis

29
Q

Causes of erythroderma

A 
eczema
psoriasis
drugs e.g. gold
lymphomas, leukaemias
idiopathic
30
Q

What is erythrodermia?

A

Erythroderma is a term used when more than 95% of the skin is involved in a rash of any kind.

31
Q

What is Erythrodermic psoriasis?

A

may result from progression of chronic disease to an exfoliative phase with plaques covering most of the body. Associated with mild systemic upset
more serious form is an acute deterioration.

32
Q

Erythrodermic psoriasis triggered by?

A

may be triggered by a variety of factors such as withdrawal of systemic steroids.

33
Q

mx Erythrodermic psoriasis

A

Patients need to be admitted to hospital for management

34
Q

What is Hirsuitism and hypertrichosis?

A

Hirsutism is often used to describe androgen-dependent hair growth in women, with hypertrichosis being used for androgen-independent hair growth

35
Q

most common causes of hirsutism

A

Polycystic ovarian syndrome

36
Q

Causes of PCOS?

A 
Cushing's syndrome
congenital adrenal hyperplasia
androgen therapy
obesity: thought to be due to insulin resistance
adrenal tumour
androgen secreting ovarian tumour
drugs
37
Q

Drugs that cause PCOS

A

phenytoin, corticosteroids

38
Q

Assessment of hirsutism

A

Ferriman-Gallwey scoring system: 9 body areas are assigned a score of 0 - 4, a score > 15 is considered to indicate moderate or severe hirsutism

39
Q

Management of hirsutism

A

advise weight loss if overweight
cosmetic techniques such as waxing/bleaching - not available on the NHS
consider using combined oral contraceptive pills such as co-cyprindiol (Dianette) or ethinylestradiol and drospirenone (Yasmin). Co-cyprindiol should not be used long-term due to the increased risk of venous thromboembolism
facial hirsutism: topical eflornithine - contraindicated in pregnancy and breast-feeding

40
Q

Causes of hypertrichosis

A

drugs: minoxidil, ciclosporin, diazoxide
congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis
porphyria cutanea tarda
anorexia nervosa

41
Q

What is Pellagra?

A

Pellagra is a caused by nicotinic acid (niacin) deficiency. The classical features are the 3 D’s - dermatitis, diarrhoea and dementia.

Pellagra may occur as a consequence of isoniazid therapy (isoniazid inhibits the conversion of tryptophan to niacin) and it is more common in alcoholic

42
Q

Features of Pellagra?

A

dermatitis (brown scaly rash on sun-exposed sites - termed Casal’s necklace if around neck)
diarrhoea
dementia, depression
death if not treated

43
Q

What are Spider naevi

A

Spider naevi (also called spider angiomas) describe a central red papule with surrounding capillaries. The lesions blanch upon pressure. Spider naevi are almost always found on the upper part of the body.

Spider naevi can be differentiated from telangiectasia by pressing on them and watching them fill. Spider naevi fill from the centre, telangiectasia from the edge .

44
Q

Around 10-15% of people will have one or more spider naevi

A

true

45
Q

Spider naevi more common in childhood

A

false

46
Q

Causes of spider naevi

A

liver disease
pregnancy
combined oral contraceptive pill

47
Q

most important causes of pruritus?

A 
Liver disease
Iron deficiency anaemia
Polycythaemia
Chronic kidney disease
Lymphoma
Other causes:
hyper- and hypothyroidism
diabetes
pregnancy
'senile' pruritus
urticaria
skin disorders: eczema, scabies, psoriasis, pityriasis rosea
48
Q

Describe pruritus in Liver disease?

A

History of alcohol excess
Stigmata of chronic liver disease: spider naevi, bruising, palmar erythema, gynaecomastia etc
Evidence of decompensation: ascites, jaundice, encephalopathy

49
Q

Describe pruritus in Iron deficiency anaemia?

A

Pallor

Other signs: koilonychia, atrophic glossitis, post-cricoid webs, angular stomatitis

50
Q

Describe pruritus in Polycythaemia?

A

‘Ruddy complexion’
Gout
Peptic ulcer disease

51
Q

Describe pruritus in Lymphoma?

A

Night sweats
Lymphadenopathy
Splenomegaly, hepatomegaly
Fatigue

52
Q

Describe Porphyria cutanea tarda

A

Porphyria cutanea tarda is the most common hepatic porphyria.

53
Q

Causes Porphyria cutanea tarda?

A

It is due to an inherited defect in uroporphyrinogen decarboxylase or caused by hepatocyte damage e.g. alcohol, hepatitis C, oestrogen.

54
Q

Features of Porphyria cutanea tarda?

A

classically presents with photosensitive rash with blistering and skin fragility on the face and dorsal aspect of hands (most common feature)
hypertrichosis
hyperpigmentation

55
Q

Investigations of Porphyria cutanea tarda?

A

urine: elevated uroporphyrinogen and pink fluorescence of urine under Wood’s lamp
serum iron ferritin level is used to guide therapy

56
Q

mx Porphyria cutanea tarda?

A

chloroquine
venesection
preferred if iron ferritin is above 600 ng/ml

57
Q

What is lichen planus?

A

Lichen planus is a skin disorder of unknown aetiology, most probably being immune-mediated.

58
Q

Features of lichen planus?

A

itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
rash often polygonal in shape
oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa
nails: thinning of nail plate, longitudinal ridging

59
Q

What eponymous features will you see in Lichen Planus?

A

‘white-lines’ pattern on the surface (Wickham’s striae)

Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma)

60
Q

Lichenoid drug eruptions - causes:

A

gold
quinine
thiazides

61
Q

Mx lichen planus?

A

potent topical steroids are the mainstay of treatment
benzydamine mouthwash or spray is recommended for oral lichen planus
extensive lichen planus may require oral steroids or immunosuppression

4th year passmedicine by topic (96 decks)

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