drug eruption; drug rash
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Classification
- morbilliform drug eruption (erythematous drug eruption) most common
- fixed drug eruption
- urticaria
- drug hypersensitivity syndrome
- photosensitivity
- erythema multiforme-like reaction
- acneiform reaction
- new onset psoriaform eruptions
- subacute cutaneous lupus erythematosus
- dermatomyositis-like eruptions
- Sweet syndrome
- eczema-like reactions
Etiology
- morbilliform drug eruption (erythematous drug eruption) most common
- penicillin & other beta-lactam antibiotics
- carbamazepine
- allopurinol
- gold
- all patients with Epstein-Barr virus or cytomegalovirus infection will develop rash if given ampicillin or amoxicillin
- fixed drug eruption
- phenolphthalein
- tetracyclines
- sulfonamides
- metronidazole
- non-steroidal anti-inflammatory drugs
- barbiturates
- oral contraceptives
- quinine, including tonic water
- peas, beans & lentils have been implicated
- urticaria
- antibiotics & most classes of other drugs
- radiocontrast agents
- hypersensitivity
- photosensitivity
- amiodarone
- thiazide diuretics
- tetracyclines
- sulfonamides, furosemide
- phenothiazines
- psoralins
- can occur with light exposure through windows
- erythema multiforme-like reaction
- acneiform reaction (not true acne, follicular reaction)
- EGF inhibitors
- new onset psoriaform eruptions
- TNF inhibitors, especially in patients with Crohn's disease or rheumatoid arthritis
- subacute cutaneous lupus erythematosus
- dermatomyositis-like eruptions
- drug-induced Sweet syndrome is rare
- eczema-like reactions
* histopathological pattern may be unrelated to etiologic agent[3]
Epidemiology
- drug eruptions most commonly caused by
- antibiotics
- penicillins
- beta-lactams
- dulfonamides
- NSAIDs
- thiazide diuretics
- allopurinol
- antibiotics
Pathology
- histopathological pattern may be unrelated to etiologic agent[3]
Clinical manifestations
- depends upon etiology, see
- distribution generally includes trunk & often the extremities[2]
- erythema multiforme-like reaction
- mucous membrane involvement common
- ocular involvement may lead to blindness
- psoriaform eruptions
- Grotton papules in dermatomyositis-like eruptions
- severe drug eruption
- confluent erythema
- skin pain
- facial edema
- fever
- lymphadenopathy
- mucosal erosions
- widespread blistering
- purpura
- necrosis
- dyspnea
- hypotension
Laboratory
- complete blood count (CBC)
- serum ALT & serum AST may be elevated
- anti-SSA in serum (associated with lupus)
- anti-histone antibodies generally negative
Complications
- erythema multiforme-like reaction
Management
- morbilliform drug eruption
- fixed drug eruption: potent topical glucocorticoids
- urticaria
- see urticaria
- antihistamines
- epinephrine for associated anaphylaxis
- systemic glucocorticoids for severe reactions
- photosensitivity
- avoid sunlight, wear protect clothing, sunscreen
- antihistamines for pruritus
- topical glucocorticoids
- erythema multiforme-like reaction
- antihistamines for pruritus
- systemic glucocorticoids for severe reactions (effectiveness not proven)
- acneiform reaction
- new onset psoriaform eruptions
- subacute cutaneous lupus erythematosus
- dermatomyositis-like eruptions: none
- Sweet syndrome
- eczema-like reactions
More general terms
More specific terms
References
- ↑ 1.0 1.1 Medical Knowledge Self Assessment Program (MKSAP) 15, 16. American College of Physicians, Philadelphia 2009, 2012
- ↑ 2.0 2.1 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
- ↑ 3.0 3.1 3.2 3.3 Summers EM, Bingham CS, Dahle KW, et al. Chronic eczematous eruptions in the aging: further support for an association with exposure to calcium channel blockers. JAMA Dermatol. 2013;149(7):814-818. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23636109
- ↑ 4.0 4.1 Orme S, da Costa D. Generalised pruritus associated with amlodipine. BMJ. 1997;315(7106):463. PMID: https://www.ncbi.nlm.nih.gov/pubmed/9284667