Drug induced derm Flashcards
4 categories of DID
Exanthematous
Uticarial
Blistering
Pustular
Exanthematous
Maculopapular eruption vs Dress
Uticarial
Angioedema vs serum sickness-like
Blistering
Fixed drug eruption vs SJS/TEN
Pustular
Acneiform vs AGEP
Dress duration
Onset 1-6 weeks
Resolve 6-8 weeks
Maculopapular eruption duration
onset 7-10 days
resolve 7-14 days
Uticarial angioedema duration
mins-hr
Serum sickness-like duration
onset 1-3 weeks
resolve 1-2 weeks
Fixed drug eruption duration
onset mins-days
resolve days
SJS/TEN duration
onset 7-15 days
AGEP duration
onset <3 days
Drugs- DRESS
“SAAD”
Sulfa
Allopurinol
Anticonvulsants
Dapsone (sulfa)
Drugs – SJS/TEN
“SPAAN”
Sulfa
Penicillins
Allopurinol
Anticonvulsants
NSAID “-cams”
HLAB58:01
Allopurinol, asian ethnicity
HLAB*1502
carbamazepine, phenytoin, phenobarbital, asian ethnicity
Dress
t cell activation
errpution + fever
>50% BSA
Allopurinol and risk for DRESS
excess dose
renal dysfunction
thiazide use, HTN
asian
Renal dosing for allopurinol
1.5 mg x eGFR (ml/min)
Dress Tx
Organs? liver, kidney, lung
Y = Systemic steroids (0.5-2mg/kg/day)
N= topical steroids (high potency)
High potency steroids
Triamcinolone 0.5
Fluocinonide
Betamethasone 0.05
Fluocinonide/halicinonide
Low potency steroids
Hydrocortisone
Desonide
Triamcinolone 0.025
Betametasone VALERATE 0.1
dexamethasone??
SJS/TEN
acute mucocutaneous, cytotoxic T cell activation
- keratinocyte apoptosis (granulysin/fas ligand)
- painful bullous formation + fever
Risk for developing SJS/TEN
HIV infection
Lupus (SLE)
Malignancy
Uv light/radiation
HLAB1502
Maculopapular
most common
presents as a RASH
Uticarial angioedema
Type 1 hypersensitivty
IgE mediated
HIVES
Fixed drug erruption
blisters that re-occur in the same place
Drug cross reactivity
very minimal between sulfa vs sulfa abx
Sulfa meds
loop diuretic, thiazide, sulfasalazine,
crossreactivity of PCN and Ceph
1-2%
based on R1 side chain
