Drug eruptions: Exanthematous

Question 1

EXANTHEMATOUS DRUG REACTION Clinical Feature

Answer 1

• morphology:erythematous macules and papules±scale

Question 2

EXANTHEMATOUS DRUG REACTION spread

Answer 2

• spread:symmetrical,trunk to extremities

Question 3

EXANTHEMATOUS DRUG REACTION course

Answer 3

• time course:7-14dafter drug initiation,fades 7-14 d after withdrawal

Question 4

EXANTHEMATOUS DRUG REACTION Epidemiology

Answer 4

most common cutaneous drugreaction; increased inpresenceof infections

Question 5

EXANTHEMATOUS DRUG REACTION commoncausativeagents:

Answer 5

penicillin, sulfonamides, phenytoin

Question 6

EXANTHEMATOUS DRUG REACTION Management

Answer 6

• weigh risks and benefits of drug discontinuation • antihistamines, emollients, topical steroids

Question 7

DIHS
DRESS
Meaning

Answer 7

DRUG INDUCED HYPERSENSITIVITY SYNDROME (DIHS) / DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS)

Question 8

DIHS
DRESS
Clinical Feature Morphology

Answer 8

morbilliform rash involving face, trunk,arms; can have facial edema

Question 9

DIHS
DRESS
• systemic features:

Answer 9

:fever, malaise, cervicallymphadenopathy, internal organ involvement (e.g.
hepatitis, arthralgia, nephritis, pneumonitis, lymphadenopathy, hematologic abnormalities, thyroid
abnormalities)

Question 10

DIHS
DRESS
spread

Answer 10

:starts with face or periorbitally and spreads caudally; no mucosal involvement

Question 11

DIHS
DRESS
time course

Answer 11

:onset 1-6 wk after first exposure todrug; persists wk after withdrawal of drug

Question 12

DIHS
DRESS
Epidemiology

Answer 12

• rare: incidence varies considerably depending On drug

Question 13

DIHS
DRESS
common causative agents:

Answer 13

• common causative agents: anticonvulsants (e.g.phenytoin, phenobarbital ,carbamazepine, lamotrigine),
sulfonamides, and allopurinol

Question 14

DIHS
DRESS
Mortality

Answer 14

• 10% mortality if severe, undiagnosed, and untreated

Question 15

DIHS
DRESS
Management

Answer 15

• discontinue offending drugs ±prednisone 0.5mg/kg/d,consider cyclosporine in severe cases • may progress to generalized exfoliative dermatitis/erythroderma if drug is not discontinued