Workshop: Fever and Rash Flashcards
Consider ___ ___ ___ ___(SCAR) when patients
present with fever and rash
Consider Severe Cutaneous Adverse Reactions (SCAR) when patients present with fever and rash
different SCARS
morbiliform drug eruption
DRESS: drug reaction eosinophilia systemic symptoms
SJS/TEN
T/F DRESS syndome is acute
false. it takes longer to occur, like 50-60 days.
most important thing when suspecting a SCARS occurrence
stop the offending agent. If youa re considered a drug rash- STOP the culprit medications.
In this situation, the morphology of the rash is not as important but rather:
• Is the patient systemically well?
- Is there fever?
- ** Is there skin sloughing or necrosis, blistering?
classic rash
urticaria-like raised patches… classic mubiliform rash
classic rash
erythematous pin point papules that are coalescing into a white spread plaque. morbiliform rash.
mobiliform rash coalescing into plaque
what else might you want to know to help differneitate a mobiliform eruption from a SCAR?
fever/systemically well?
drug history chronology
SA involvemnet
family clinic or emergency
most common of all medication-induced drug rashes. which part of the body does it NOT occur?
mobiliform or exanthematous drug eruption
- most common of all medication-induced drug rashed
- red macules and papules that often arise on the trunk and spread symmetrically to involve the proximal extremities
- palms, soles, and mucous membranes generally not a feature.
how is this morphology different than a morbiliform rash?
it is more widespread plaque. facial involvement. this is a more extreme morbiliform picture– erythroderma or DRESS syndrome: Drug Reaction with Eosinophilia and Systemic Symptoms
erythroderma is not a diagnosis– it’s a descriptor for widespread erythematous rash
which demographic is more associated with DRESS syndrome? what is a hall mark trait? what other systemic symptoms occur?
higher incidents in african, caribbean people
- 2-8 weeks after drug starting with SYSTEMIC FEVER AND RASH Athat starts on face, upper trunk
- EDEMA OF FACE is hallmark
- lymph nodes are enlarged and liver hepatitis is associated. there’s also systemic symptoms like myocardidits, interstitial pneumonitis, interstitial nephritis, thyroiditisi
note:
erythematous plaque with erosion centrally and impending necrosi. looks like TEN or SJS
key sign of SJS or TEN
nicholsky’s sign; rolled up epidermis causing an erosion. there is extensive exfoliation of epidermis due to death of keratinocytes
oral erosion and necorsis due to SJS/TEN
note:
which alleles have a higher chance of developing SJS or TEN
HLA alleles
• HLA alleles** have an awareness to check for this prior to starting
medications!
• HLA-B*1502 in Asians and East Indians with carbamazepine
• HLA-B*5801 in Han Chinese with allopurinol
• HLA-A*3101 Europeans with carbamazepine
characteristic papule
target papule: three rings which can be seen in SJS or erythema multiforme (related to HSV)
erythema multiforme (related to HSV)
erythema multiforme (related to HSV)
how is erythema multiforme different than other severe adverse cutaneous drug reactions?
on palms/soles
- clsasic mucositis
3. classic target papules - related to HSV
erythema multiform major vs minor
• EM MINOR= target lesions with little or no mucosal involvement and no
systemic symptoms • EM MAJOR= papular target lesions with severe mucosal involvement and
systemic features
T/F EM can progress to TEN
false.No risk to progress to TEN or SJS. EM almost always precedes HSV, whereas TEN and SJS is drug-induced often.
