exanthematous drug eruption (morbilliform exanthem)
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Introduction
Morbilliform exanthem due to drug reaction.
Etiology
- amoxicillin (5%)
- Bactrim (3%)
- ampicillin (3%)
- cephalosporins (2%)
- semisynthetic penicillins (2%)
- erythromycin (2%)
- penicillin G (2%)
- quinidine (1%)
- cimetidine (1%)
- allopurinol (1%)
- barbiturates
- indapamine
- methyldopa
- phenytoin
- captopril
- gold
- carbamazepine
- sulfonamides (including diuretics)
- NSAIDs
Epidemiology
- common in geriatric patients due to polypharmacy
- most common type of cutaneous drug eruption
Pathology
Clinical manifestations
- commonly occurs 1-3 weeks after initiation of drug
- may occur sooner if exposure is recurrent[2]
- may occur at any time or with change is dose
- erythematous macules or papules which may become confluent
- symmetric distribution on trunk & extremities
- palms & soles generally spared[2]
- pruritus variable
- lymphadenopathy common
Laboratory
- complete blood count may show eosinophilia
Complications
- may become generalized exfoliative erythroderma
Differential diagnosis
- pseudoallergies, drugs that release histamine
- photosensitivity
- other dermatitis
Management
- discontinue offending agent
- supportive care
- topical antipruritics containing menthol
- antihistamines
- medium-potency topical glucocorticoids[2]
- short prednisone taper (1 week)
More general terms
More specific terms
References
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39
- ↑ 2.0 2.1 2.2 2.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 17, 19 American College of Physicians, Philadelphia 1998, 2015, 2022
- ↑ Takahashi S, In: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
- ↑ Prescriber's Letter 14(10): 2007 Management of common skin diseases Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=231011&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Stern RS. Clinical practice. Exanthematous drug eruptions. N Engl J Med 2012 Jun 29; 366:2492 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22738099 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcp1104080
- ↑ Kroshinsky D Adverse cutaneous reactions to medications Clin Dermatol. 2020 Nov-Dec;38(6):605-606 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33341194