Drug induced rashes

Question 1

What are examples of rashes induced by drugs?

Answer 1

Morbilliform, Hives, Photo-sensitive reactions, SJS/TEN

Question 2

What is the most common form of drug eruption?

Answer 2

Morbilliform

Question 3

What is morbilliform drug eruption

Answer 3

A measles like drug eruption due to drugs
Antibiotics are the most common group responsible for morb
90% of drug reactions

Question 4

How to morbilliform eruptions look like

Answer 4

Measles/ Rash (exanthems) caused by viral or bacteria infections
MACULOPAPULAR

Question 5

What is the cause of morbilliform skin rash in adults? Kids?

Answer 5

Adults usually due to drug
Kids are usually viral origin

Question 6

What is the prevalence of morbilliform drug reactions?

Answer 6

2% of rx of new drugs cause a drug eruption and 95% of these cases are morbilliform

Question 7

What are the clinical features of morbilliform drug eruption?

Answer 7

Usually appears 1-2 weeks after starting the drug, may occur up to 1 week after stopping drug
It is rare for a drug that has been taken for months or years to cause a morbilliform drug eruption
Appears in the trunk region and spreads to the limbs and the upper neck
Maculopapular
Rash may be associated with mild fever and itch (not infection, but actually drug rxn)

Question 8

What is the treatment for a morbilliform drug eruption?

Answer 8

Stop taking the drug
Antihistamines (but not super helpful)
Wet wraps for red, inflammed skin
emollients and potent topical steroids

Question 9

What are the common drugs responsible for morbilliform rashes?

Answer 9

penicillin
sulfa drugs
cephalosporins
anti-seizure drugs
allopurinol

Question 10

What is the outlook for morbilliform drug eruption?

Answer 10

After the causative drug is ceased, the rash begins to improve within 48 hours and clears within 1-2 weeks

Question 11

What to do if a pharmacist notices blisters or pus-filled morbilliform rashes?

Answer 11

Be worried and out of our scope, refer

Question 12

What is the difference between a drug rash and hives?

Answer 12

Drug rashes have some itching or tenderness
Hives are super itchy!

Question 13

What is the second most common type of drug rash?

Answer 13

Urticarial rashes or hives

Small pale red bumps that can form larger patches. V itchy

Question 14

What are the common drugs for urticarial drug rashes?

Answer 14

NSAIDs
ACEi
Antibiotics –> penicillin
General anesthetics

Question 15

What are the second most frequent cause of allergic drug reactions?

Answer 15

Antimicrobial sulfonamides
Less than 5%

Question 16

What is a phototoxic reaction?

Answer 16

Accelerated sunburn appearance
Clears up once the drug is d/c and has been cleared by the body

Question 17

What is a photoallergic reaction?

Answer 17

Allergic response from the sun-exposed areas
Resemble eczema and are generally chronic
Mainly topical drugs
photosensitivity even after the drug has cleared from the system

Question 18

True or False: SJS/TEN is a rare disease

Answer 18

True 1 to 2 people per million people in a year

Question 19

What are the common drugs that cause SJS

Answer 19

Gout medicines -> allopurinol
Pain relievers -> acetaminophen, ibuprofen, naproxen
Sulfa antibiotics
Mental illness or seizure medications

Question 20

How long is SJS treatment?

Answer 20

8 weeks following the first exposure to the causative agent

Question 21

What are the symptoms of SJS (Stevens-Johnson syndrome)

Answer 21

Skin pain is the most common symptom
Flu-like symptoms during the initial stages
- high temp, headache, joint pain, cough
After a few days:
- rash appears, which contains blemishes with dark centers
- not itchy and spreads over hours or days
- eventually large blisters on skin with painful sores and bursting

Question 22

When should a patient consult a doctor when they have a rash?

Answer 22

Rash covering whole body
Temperature indicating infection or allergic reaction
Rash is spreading quickly (hives can spread quickly though)
Rash is very painful
Fluid-filled blisters or open sores
Infection signs such as pus, swelling, warmth, or extreme pain
OTC creams or Anti-He have failed to work
Rash impairing daily activities
Rash during pregnancy

Question 23

What happens if a patient is exposed again to the drug rash causing agent?

Answer 23

No reaction
Same reaction
or Worse reaction