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Dermatology > Drug eruptions > Flashcards

Drug eruptions Flashcards

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Dermatology Board Prep flashcards
1
Q

What percentage of drug reactions are cutaneous?

A

30%

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2
Q

Drug eruptions are becoming harder to diagnose because of polypharmacy. T/F

A

True - they are also particularly difficult to diagnose in childhood

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3
Q

Immunologically mediated drug eruptions are dose-dependent. T/F

A

False! - however, non-immune mediated drug eruptions may be dose dependent

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4
Q

What do the different types of immune reaction typically present as in a drug eruption?

A

Type 1 - urticaria
Type 2 - phemphigus & phemphigoid
Type 3 - purpura/rash
Type 4 - erythema/rash

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5
Q

Give some examples of non-immune mediated drug eruptions.

A 
Eczema
drug-induced alopecia (e.g chemo)
phototoxicity
skin erosion/atrophy (e.g steroids)
psoriasis (e.g lithium)
pigmentation
 xerosis (dry skin) or cheilitis (dry lips)
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6
Q

List the most common presentations of drug eruption in descending order.

A 
Erythematous morbilliform/maculopapular rash >
Urticarial >
Papulosquamous/pustural/bullous >
Pigmentation w/ or w/o itch/pain > 
Photosensitivity
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7
Q

Drug eruptions are usually symmetric. T/F

A

True (but fixed drug reactions may occur)

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8
Q

Why might the symptoms of a drug eruption not resolve after the drug is withdrawn?

A

The drug may have a long half life, be retained in tissues or have there may be cross reaction with a similar class of drugs

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9
Q

What are the risk factors for developing a drug eruption?

A

Being young, female, genetically predisposed, having concomitant disease (viral infections or CF) or having a previous immune reaction/positive skin test

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10
Q

What factors make a drug more likely to cause an immune reaction?

A 
B-lactam containing drugs
NSAIDs
High molecular weight drugs
Hapten (antibody eliciting) forming drugs
Topically applied drugs
High dosage 
Long half-life
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11
Q

What type of drug reaction is an erythematous reaction?

A

Type 4

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12
Q

Erythematous drug reactions are idiosyncratic. T/F

A

True

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13
Q

Describe the features of an erythematous drug reaction

A

Mild & self limiting
Symmetrically distributed & widespread
No/minimal involvement of mucous membranes
Commonly itch & mild fever

(NOTE - capable of progressing to life threatening levels)

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14
Q

What is the time of onset of a erythematous drug reaction?

A

4-21 days after drug exposure

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15
Q

In relation to an erythematous drug reaction, what are some indicators of severity?

A 
Mucous membrane & facial involvement
Facial oedema & erythema
Widespread, confluent erythema
High fever
Blisters, purpura or necrosis
Lymphadenopathy 
Arthralgia 
SOB, wheezing
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16
Q

Give examples of some drugs associated with erythematous drug eruptions

A 
Penicillins
Erythromycin
Steptomycin 
Anti-epileptics (carbamazepine) 
NSAIDs
Sulphonamide antibiotics
17
Q

What type of drug reactions are utricarial?

A

Type 1 (b-lactam antibiotics, carbazeine) OR direct mast cell degranulation on first exposure (NSAIDs, aspirin, opiates, vancomycin)

18
Q

What are the two types of pustular reactions?

A

Acne

Acute generalised exanthematous pustulosis (AGEP)

19
Q

Give examples of some drugs which may cause an acne drug eruption.

A 
Glucocorticoids
Androgens 
Lithium
Isoniazid 
Pheytoin
20
Q

Give examples of some drugs which may cause an AGEP drug eruption

A

Antibiotics
Calcium channel blockers
Anti-malarials

21
Q

Give some examples of drugs which may cause bullous pemphigoid

A

ACE inhibitors, penicillin, furosemide

22
Q

Which drug has the potential to trigger linear IgA disease?

A

Vancomycin

23
Q

Describe fixed drug reactions

A

Well demarcated round plaques
Red & painful
Usually mild when restricted to a single lesion
(NOTE - may present as eczematous lesions, papules, vesicles or urticaria)

24
Q

Where are fixed drug eruptions most commonly distributed?

A

Hands, genitals, lips & occasionally oral mucosa

25
Q

When the offending drug is stopped what happens to a fixed drug reaction?

A

Persistant pigmentation

26
Q

Give examples of drugs which are commonly associated with fixed drug eruptions

A

Tetracycline, doxycycline, paracetamol, NSAIDs, Carbamazepine

27
Q

Give examples of severe cutaneous reactions

A

Stevens-Johnson syndrom (SJS)
Toxic Epidermal Necrolysis (TEN)
Drug reaction with eosinophilia and systemic symptoms (DRESS)
Acute generalised exanthematous pustulosis (AGEP)

28
Q

Describe severe cutaneous reactions

A

SJS - blistering in oral & genital mucosa
TEN - looks like a whole body burn, positive precursky skin, hypothermic, risk of sepsis
DRESS - facial oedema, lymph node swellings, high temperatures

29
Q

What are the acute and chronic signs of phototoxicity?

A

Acute - skin toxicity, systemic toxicity, photodegredation

Chronic - pigmentation, photoaging, photocarcinogenesis

30
Q

What is a photocutaneous drug reaction?

A

A non-immunologically mediated skin reaction which can occur in any individual providing there is enough photo-reactive drug & the appropriate wavelength of light

31
Q

Which wavelengths of light typically cause photocutaneous drug reactions?

A

UVA and visible light

32
Q

How may increased sensitivity to sunlight occur without the use of phototoxic drugs?

A

Immunosuppression may increase sensitivity to sunlight

33
Q

What are the major patterns of cutaneous phototoxicity? Give an example of a drug which may cause each pattern

A

Immediate prickling with delayed erythema and pigmentation (amiodarone)
Exaggerated sunburn (thiazides)
Exposed telangiectasia (calcium channel antagonists)
Delayed (3-5 day) erythema and pigmentation (psoralens)
Increased skin fragility (amiodarone)

34
Q

What is the most common pattern of cutaneous phototoxicity?

A

Exaggerated sunburn

35
Q

List some drugs which cause phototoxicity

A 
NSAIDs
Psoralens
Antifungals (voriconazole)
Thiazide diuretics 
Antibiotics
Amiodarone
36
Q

When is skin testing absolutely not indicated in the context of cutaneous drug reactions?

A

Type 3 and type 4 immune reactions

37
Q

Immunocompromised patients are more likely to suffer severe cutaneous reactions. T/F

A

True

38
Q

How might a drug reaction be managed?

A

Discontinuing use of drug
Topical steroids
Antihistamines

Dermatology (26 decks)

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