Drug Eruptions

Question 1

Severe cutaneous adverse drug reactions

Answer 1

Stevens-Johnson syndrome
Toxic epidermal necrolysis
Drug reaction with eosinophilia and systemic symptoms (DRESS)
Acute generalised exathematous pustulosis (AGEP)`

Question 2

Type of drug eruptions

Answer 2

Exathematous/morbilliform/maculopapular
Urticarial drug reactions
Papulosquamous/pustular/bullous reactions
Fixed drug eruptions
Stevens-Johnson syndrome and toxic epidermal necrolysis
Drug reaction with eosinophilia and systemic symptoms (DRESS)
Phototoxic drug reactions

Question 3

Presentation of exathematous/morbilliform/maculopapular drug eruption

Answer 3

Rash starts on the torso, spreads to the face and limbs
Mucosae is spared
Itch, fever
Self-limiting (1-2wks)
2wks after onset of therapy
Can progress to a life-threatening reaction

Question 4

Drugs causing exathematous/morbilliform/maculopapular drug eruption

Answer 4

Penicillins
Sulphonamides
Erythromycin
Streptomycin
Allopurinol
Anti-epileptics
NSAIDS
Chloramphenicol

Question 5

What is the most common type of hypersensitivity rash?

Answer 5

Exathematous/morbilliform/maculopapular

Question 6

Mechanism of urticarial drug reactions

Answer 6

IgE-mediated

Drug-induced mast degranulation

Question 7

Presentation of urticarial drug reactions

Answer 7

Rapid onset after taking the drug

Wheals +/- associated angioedema or anaphylaxis

Question 8

Drugs causing IgE-mediated urticarial drug reactions

Answer 8

B-lactam antibiotics (amoxicillin)

Carbamazepine

Question 9

Drugs causing drug-induced mast degranulation urticarial drug reactions

Answer 9

Aspirin
Opiates
NSAIDS
Muscle relaxants
Vancomycin
Quinolones

Question 10

Types of papulosquamous/pustular/bullous drug eruptions

Answer 10

Acneiform
Acute generalised exanthematous pustulosis (AGEP)
Drug-induced bullous pemphigoid

Question 11

Drugs causing acneiform drug eruptions

Answer 11

Glucocorticoids 
Androgens
Lithium
Isoniazid
Phenytoin

Question 12

Drugs causing drug acute generalised exanthematous pustulosis eruptions

Answer 12

Superficial pustules (neck, axillae, groin)

Question 13

Presentation of fixed drug eruptions

Answer 13

Inflamed patches that recur at the same site each time a drug is taken
They may blister and often resolve with hyperpigmentation

Question 14

Drugs causing fixed drug eruptions

Answer 14

Tetracycline
Doxycycline
NSAIDS
Carbamazepine 
Amoxicillin

Question 15

Presentation of Stevens-Johnson syndrome and toxic epidermal necrolysis

Answer 15

1-2wks after drug exposure
Initial non-specific symptoms (malaise, myalgia, fever, cough)
TEN: blistering with skin that wrinkles like wet wallpaper on gentle pressure

Question 16

Drugs causing Stevens-Johnson syndrome and toxic epidermal necrolysis

Answer 16

Sulfonamides
Cephalosporins
Carbamazepine
Phenytoin
NSAIDs
Nevirapine
Lamotrigine
Sertraline
Pantoprazole
Tramadol

Question 17

Presentation of drug reaction with eosinophilia and systemic symptoms

Answer 17

2-6wks after drug exposure
Widespread erythema
Facial oedema
Fever
Lymphadenopathy
Hepatosplenomegaly
Blood eosinophilia

Question 18

Drugs causing drug reaction with eosinophilia and systemic symptoms

Answer 18

Sulfonamides
Anticonvulsants
Allopurinol 
Minocycline
Dapsone
NSAIDs
Abacavir
Nevirapine
Vancomycin

Question 19

Phototoxic drug reactions

Answer 19

Non-immunological skin reaction causing increased sensitivity to light
Caused by exposure to photo-reactive drugs

Question 20

Presentation of phototoxic drug reactions

Answer 20

Unexpected sunburn or dermatitis on sun exposed skin

Question 21

Drugs that cause phototoxic drug reactions

Answer 21

Antibiotics
Thiazides
Chloropromazine
NSAIDs
Quinine
Psoralens
Amiodarone
Porphyrins
BRAF inhibitors
Antifungals
Immunosuppressants