Drug-Induced Derm Flashcards
circumsised flat lesoins of any shape or size that differ from surroundings bc of their color
macules
small, raised lesions (pimple)
papules
multiple, well defined red macules of varying size that blanch upon pressure and are thus a result of inflammatory vasodilation
drug eruption
palpable, solid, round, or ellipsoidal lesions
nodules
technical term for blisters.
vesicles and bullae (bullae are >0.5cm diameter)
rounded or falt-topped papules or plaques that are evanescent (disappear quickly)
wheals
exanthematous + fever
hypersensitivity syndrome reaction (DRESS)
blistering and no fever
fixed drug eruption
urticarial and no fever
urticaria/angioedema (IgE-mediated, hives etc.)
exanthematous and no fever
simple maculopapular eruption
pustular and fever
AGEP
pustular and no fever
acneiform
blistering and fever
SJS/TEN (uh oh land)
urticarial and fever
serum sickness-like
maculopapular rash
onset
offset
causative drugs
exanthematous and no fever most common type of drug -induced dermatologic condition trunk, arms, and upper back onset at 7-10 days of drug initiation resolves in 7-14 days of d/c drug
penicillins/cephalos
sulfonamides
anticonvulsants
DRESS
definition
s/sx
offending agents
exanthematous eruption + fever, lymphadenopathy, eosinophilia, multi-organ involvement (kidney liver and lungs), facial edema, >50% of body surface area onset at 1-6wks post-initiation of drug offending agents: allopurinol #1 sulfonamides anticonvulsants (barbituates, phenytoin, carbamazepine, lamotrigine) dapsone
DRESS
patho
T cell activation and proliferation
reactivation of latent human herpes virus-6
exact patho is unknown
allopurinol-induced DRESS
risk factors
excessive allopurinol dose renal dysfxn concominant thiazide diuretic HTN asian ethnicity HLA-B*58:01
DRESS treatment
d/c offending drug
avoid starting new medications
avoid beta lacs
valproic acid is a good alternative anti-epileptic
fluid, electrolyte, and nutrition management
organ involvement?
no = high potency topical steroids BID-TID x 1wk
yes = systemic corticosteroids 0.5-2mg/kg/d prednisone equivalents, tapered over 8-12 weeks
what are some high potency steroids
clobetasol 0.05% fluocinonide 0.1%, 0.05% betamethsasone dipropionate augmented 0.05% halobetasol 0.05% halcinonide 0.1% betamethsasone dipropionate 0.05% triamcinolone cream or ointment 0.5% desocimethasone 0.05%
what are medium to low potency steroids
triamcinolone cream or ointment 0.1% mometasone 0.1% triamcinolone lotion 0.1% hydrocortisone valerate 0.2% betamethasone valerate 0.1% desonide 0.05% triamcinolone 0.025% hydrocortisone 1%
urticaria and no fever s/sx offending agents onset tx
type 1 HS rxn (IgE mediated) can be 1st sign of anaphylactic rxn hives, priuritic red raised wheals, angioedema, swelling of mucous membranes onset in minutes to hours agents: penicillins and related ABX sulfonamides ASA Opiates Latex tx: Benadryl
urticaria plus fever s/sx onset resolution offending agents tx
serum sickness-like rxn not a true serum sickness urticaria, fever, arthralgias onset at 1-3 weeks after starting drugs sx resolve within 1-2 weeks agents: penicillins/cephalos sulfonamides
Blistering with no fever (fixed drug eruption)
s/sx
onset
offending agents
simple eruptions with priuritic, erytheatous, raised lesions that can blister onset in minutes to days skin hyperpigmentation can last for months agents: TTCs barbituates sulfonamides codeine phenolphthalein APAP NSAIDs
