Contact Dermatitis/ Drug Eruptions Flashcards Preview

Dermatology > Contact Dermatitis/ Drug Eruptions > Flashcards

Flashcards in Contact Dermatitis/ Drug Eruptions Deck (114):
1

Produces parasthesias of fingertips, cyanosis, gangrene

Oxalic acid

Neutralized by limewater or milk of magnesia

2

Produces a white eschar
May cause glomerulonephritis or arrythmias

Phenol (carbolic acid)
Neutralized by ethyl or isopropyl alcohol

3

Hydrofluoric acid

Neutralize periungual burns with IL calcium gluconate
May cause low Ca, low Mg, high K and dysrrythmias

4

Lime, arsenic, zinc dust

May produce folliculitis

5

Hyperpigmentation, keratoses, scrotal cancer

InSoluble cutting oils

6

Acne corne

Follicular keratosis and pigmentation from crude petroleum

7

Acquired perforating dermatosis in field workers

Calcium chloride

8

Inhalation causes exfoliative erythroderma, eosinophilia, mucous membrane erosions and hepatitis

Trichloroethylene used as degreasing agent and dry cleaning

9

Contact urticaria

Cetyl amd stearyl alcohol

10

Produce a pustular eruption on patch testing of no clinical significance

Nickel, mercury, potassium iodide

11

Other toxicodendron reactors

Cashew (nutshell), rengas tree, spider flower, silver oak

12

Rescorcinol allergy

Person is elliptical, wheat bran, marine brown algae

13

Prevents or diminishes poison ivy

Quaterinium 18 bentonite

14

Sites of early mango dermatitis

Eyelids and prepuce bc from palms

15

Ingestion of ginkgo fruit results in

Perianal dermatitis

16

Most common cause of allergic dermatitis in florists

Peruvian lily

17

Antigenic site of sesquiterpene

Alpha methylene portion

18

Causes a severe inflammatory bullous rxn

Prairie crocus

19

Contact urticaria and anaphylaxis

Onion and celery

20

Cause erythema multiforme

Tea tree oil, cocobolo, rosewood (exotic woods), Bermuda fire sponge

21

Seaweed dermatitis

Blue green algae (lyngbya), within minutes, area covered

22

Sabra dermatitis

Prickly pear and fig
Resembles scabies

23

Pastry baker hand dermatitis

Cinnamon

24

Dentist dermatitis

Eugenol, clove oil, eucalyptus oil

25

Allergic sensitizerbof turpentine

Carlene

26

Best screening agents for clothing dermatitis

Ethylene urea melamine formaldehyde resin, dimethylol dihydroxyethylene

27

Shoe dermatitis

Rubber accelerators like mercaptobenzothiazole, carbamates, tetramethylthiuram disulfide, K dichromate

*spares web spaces

28

Black dermatographism

Under jewelry containing zinc, titanium oxide on gold jewelry

29

Addition of this to cement decreases chrome dermatitis

Ferrous sulfate

30

Most common component of thimersol to cause ACD

Ethyl mercuric

*those who react to thiosalicilic acid component have piroxicam allergy

31

Glove allergy

Thiuram

32

Dental bonding agents

Bisphenol A and glycidyl methacrylate

33

Orthopedist allergy

Methyl methacrylate monomer

34

Most common fragrance allergies

Cinnamic alcohol, oak moss, cinnamic aldehyde, hydroxy citronellal, musk ambrette, isoeugenol, geraniol, coumarin, Lyral, eugenal

35

What color of hair dyes cross react with PPD

Azo dyes - acid violet 6b, water soluble nigrosine, ammonium carbonate

36

May produce a localized urticarial and generalized histamine reaction

Ammonium persulfste

37

Allergin of propolis (lip balm, lipstick)

Caffeates

38

Highest rate of allergy among transdermal meds

Clonidine

*TD meds may have EM like reaction

39

Anamnestic reaction (recall if sensitized topically then taken internally flare at previous site of ACD)

Antihistamines
Sulfonamides
PCN

40

Late patch reaction, 7 d

Neomycin

41

Topical ab with highest rate of contact urticaria and anaphylaxis

Bacitracin

42

Highest rates of occupational skin disease

Agriculture, fishing, forestry

43

MC cause of contact urticaria

Nonimmunologic - no prior sensitization

Causes - nettle, DMSO, sorbic acid, benzoic acid, cinnamic aldehyde, cobalt, trafuril

44

Immunologic urticaria

Latex, potatoes, phenylmercuric propionate

45

Groups with highest risk of latex allergy (type 1)

Atopic and spina bifida

Banana, avocado, kiwi, chestnut, passion fruit
Open patch tests best for immediate type hypersensitivity
Rast detects 75% of latex allergy

46

MC drug allergy

Simple exanthems
F MC, except males under 3
Occur within 2 weeks but up to 10 d after stopping drug
PCNs and Bactria MC
May have UV recall

47

Type 1 hypersensitivity

Skin testing useful

48

Cells imp in patho of ADR

Th1

49

Bullous drug without epidermal necrosis

Th1- induce IFN gamma

50

Th2

Morbilliform and urticarial

Others
CD8 which secrete perforin, granzyme B and FAS ligand causing keratinocytes apoptosis, most dangerous

T cells via GM-CSF and IL8 for agep

51

Treg markers

Dermal CD4+CD25+foxp3 regulatory T cells reduced in bullous drug eruptions like ten

*tregs with skin homing molecules inreased in early drug hypersensitivity - immunologically active early to suppress immune function but become functionally deficient ( explains autoimmune sequela later in dress)

52

Sulfa dress crossreactors

Long acting sulfonamides - sulfamethoxazole, sulfadiazine, sulfasalazine

NOT sulfonylureas, thiazides, furosemide or acetazoleamide

53

Early and late dress findings

Early - interstitial nephritis
Late - SIADH, graves, DM, SLE

54

COD in dress

Liver or renal

55

Directly induces HHV6

Sodium valproate *one study showed all fatal dress cases associated with HHV6 reactivation

56

MC AED to cause dress

Carbamazepine

*hhv6 and 7 reactivation more commonly seen with carb

57

MC finding in anticonvulsant hypersensitivity syndrome

Fever (50%) adenpoathy (20%), elevated LFT's ( btw 2/3 and 3/4 of cases)

58

Lamotrogine dress

Less eosinophilia, LAD and multi organ involvement
Usually occurs within 4 week, may take up to 6 months
Coadministration of valproate increases risk of lamotrigine dress
Slow introduction decreases the risk

59

Safe alternative for anticonvulsant hypersensitivity

Valproate

60

Allopurinol hypersensitivity

Normal occurs in the setting of renal failure
MCC of death - CV (25%)
Pancreatitis and DM may develop
Dialysis does not hasten resolution of the eruption

61

Sulfonamides hypersensitivity due to?
What AED cross reacts?

Slow acetylators
Zonisamide (but not with other AEDs)

62

HLA in allopurinol hypersensitivity

HLA-B-5801 in Han Chinese

63

Minocycline hypersensitivity

Deficiency of glutathione a transferase common
Typically begins 2-4 weeks later
Fever, rash and LAD in >80%
HA and cough common
Liver inv in 75%
*particularly associated with interstitial pneumonia with eosinophilia

64

Dapsone hypersensitivity

Usually begins 4 or more weeks later
Icterus and LAD in 85%
Eosinophilia typically NOT present
Elevated bili in 85% (partially from hemolysis)
Liver inv mixture of hepatocellular and cholestatic
Low albumin is characteristic

65

Han Chinese hla in SJS/TEN

HLA-B-1502

66

MCC of SJS in kids

Sulfonamides - MC in spring

67

Not part of scorten but bad prognostic indicator

Respiratory involvement

68

May precede SJS

Fever and flu like eruption

69

Level correlates with BSA involvement in SJS

Soluble Fas Ligand

70

MC sequale of SJS

Ocular scarring and vision loss

*other include cutaneous scarring, eruptivr nevi, nail abnormalities, transient widespread verrucous hyperplasia resembling SK's

71

Radiation induced erythema multiforme

Occurs in NSG pts on phenytoin and steroids who get full brain XRT
Spreads caudad a similar syndrome seen with amifostine

72

Cd4 count in HIV with high rate of ADR

25-200

Hepatitis but not cutaneous reactions MC if cd4 is above 200

73

Increased risk of SJS

Nevirapine, especially HLA-DRB1*0101

74

Abacavir hypersensitivity

HLA-B*5701

75

MC location of fixed drug

1/2 are oral or genital (erosive symmetric vulvitis)

76

Cause of FDE with predilection for lips

NSAIDS - especially pyrazolinr derivavtives, paracetamol, naproxen, oxicams and mefenamic acid

*cause of majority of genital FDE - sulfonamides

77

Causes of FDE

NSAIDS, sulfonamides, barbiturates, TCN, phenolphthalein (laxatives), acetaminophen, cetirizine, celecoxib, dextromethorphan, hydroxyzine, quinine, lamotirigine, phenylpropanolamine, erythromycin, herbs

78

HLA linked to FDE

HLA-B22

79

What increases the likelihood of positive patch tests in FDE

Tape stripping

80

2 variants of nonpigmenting FDE

1) pseudocellulitis or Scarlatiniform
2) SDRIFE - giant cell lichenoid derm on path

81

Cell found in FDE

Intraepi CD8 which secretes IFN gamma
*once the med is stopped tregs clear (found fewer in number in SJS explaining persistence of rxn)

82

AGEP

Strong F predominance
Mediated by T cells which produce IL8, IFN gamma, IL4, IL5 and GM-CSF
Mercury exposure, viral/back infections, loxoceles bite, radiocontrast
>90% due to drug - amp/Amox, pristinamycin, quinolone, hydroxychloroquine, sulfonamides ab, terbinafine, imatinib, diltiazem
Fever and MM inv common (non erosive), neutrophilia > eosinophilia
Patch testing pos in 50%

83

Most common drug induced pseudolyphmphoma

Resembles CTCL, TCR may be positive

AEDs, sulfa (including thiazides), dapsone, antidepressants, vaccines, herbs

84

MCC of nonimmunologic urticaria

Aspirin and NSAIDs

*trilisate and salsate do not cross react

85

MCC of immunologic urticaria

PCN

Skin testing useful

86

Meds that cause urticaria

Bupropion (hepatitis and SSLR), cetirizine and hydrosyzine paradoxically

87

Angioedema

Blacks 5x more likely
Lisinopril/enalapril more likely than cap
1 week to months so may develop

88

Children with what dz may suffer potentially fatal macrophage activation syndrome with red men from vancomycin

JIA

Red man caused by elevated histamine levels, may see a macular eruption on the neck which spreads

89

Photosensitivity action spectra

UVA and visible 315-430)

90

Photo distributed lichenoid rxn

Thiazides, quinidine, NSAIDs, diltiazem (marked hyperpig). clopidogrel

91

Voriconazole skin manifestations

Photosensitivity (not dose dep like amiodarone), cheilitis, facial erythema, pseudoporphyria with foot erosions also, eruptive nevi and lentigines, SCCs, photodistributed GA

92

Photo distributed telangectasias

CCB, cefotaxime

*steroids, OCPs, isotretinoin, IFN, lithium, thiothixene, mtx may induce tel but not through photosensitivity

93

MCC of psudoporphyria

Naproxen

*other nsaids but not pyroxicam, TCN, lasix, isotretinoin/acitretin, 5fu, bumetanide, dapson, OCP, rofecoxib, celecoxib, CSA, voriconazole, pyridoxine dialysis (n acytelcycteine may help)
*positive DIF like PCT

94

Embolia cutis medicamentosa/ livedoid dermatitis/ Nicolau syndrome

Injection site reaction from periarterial injection
Blanching --> macule that evolves into a violations patch with dendrites --> hemorrhagic and ulcerates
Muscle and liver enz may be high
Neurological sequela in 1/3
NSAIDs, steroids, depo, IFN (unrelated agents)

95

SSLR

Minocycline, bupropion, rituximab

96

Drug induced ulceration of the lower lip

Type of lichenoid rxn
Usually to diuretics

97

Radiation recall

Months to yrs following xrt treatment recall rxn with administration of certain chemo drugs, IFN alpha and simvastatin

Similar reactivation of sunburn with mtx can occur

98

Palifermin associated papular eruption

Resembles flat warts

99

EGFR cutaneous SE

Papulopustular eruption MC - TCN may treat
TNF alpha and IL1 mediate cutaneous rxn
Curly hair and trichomegaly can be seen

100

Pso exacerbation, a real psoriasiform hyperkeratosis, PR-like eruption, periorbital edema (PDGFR inhibition)

Imatinib

101

Lobular panniculitis

Dasatinib

102

KP like eruption and KAs
Facial/scalp erythema and dysethesia

Sorafenib

103

GCSF

Injection site reactions
Sweets (1 week after initiation)
LCV
Necrotizing panniculitis
Granulomatous skin rxns

104

Granulomatous skin reactions

GCSF
Anakinra
EPO

105

IL2

Diffuse erythema followed by desquamation
Mucositis
Pruritus
Flushing

*administration of iodinated contrast material within 2 weeks of IL2 therapy will cause hypersensitivity in 30% of cases

106

TNF inhibitors

Recall injection site reaction - CD8 mediated
PP PSO in 40%
Mechanism of PSO is through TH1 and increases IFN alpha production
Sarcoid
11% of RA pts treated with etanercept develop positive ANAs, 15% dsDNA
Drug induced lupus avg after 41 weeks - compared to other DIL the tnf inh cause more malar rash, discoid lesions, photosensitivity
Vasculitis - vasculitis (p anca and cryoglob may be positive
Lichenoid drug
Sl increased Risk of NMSC's, especially if on mtx

107

Acrodynia/calomel disease

Mercury poisoning in infancy
Painful swelling of the hands/feet with cold/clammy/dusky changes
May see hemorrhagic puncta with blotchy erythema on the trunk
Stomatitis with fever
Albuminuria and hematuria
Dx - Mc in urine

*Mc inhalation may also cause a morbilliform eruption with groin/thigh accentuation like baboon syndrome

108

Bromoderma

Coalescent pustules on a raised border at the periphery of a lesion
Excessive soft drink ingestion or meds (dextromethorphan hydrobromide)

109

Iododerma

Acneiform eruption
Dermal bullous lesions

110

Drug induced SLE

Procainamide, hydralazine, quinidine, captopril, minocycline, INH, carbamazepine, propothiouracil, sulfasalazine, statins

DIL rarely has skin lesions, M=F, mild sx like fever, arthritis, serositis
ANA is positive but not dsDNA, normal C'

111

TNF alpha inhibitor induced lupus

Especially etanercept
Prominent skin lesions
F>M
Nephropathy with CNS involvement may occur
Anti-dsDNA +, hypocomplementemic

112

Drug induced SCLE

Days to yrs can occur

Terbinafine, hydrochlorothiazide, diltiazem MC
ACE inh, PPI's, statins, NSAIDs, plaqinel, leflunomide may also cause

May be ANA + and have antihistone ab but have + SSA

Photosensitive lesions but not photodistributed or annular
Etanercept may also cause SCLE

113

Leukotriene receptor antagonist Churg Strauss syndrome

2 d to 10 mo after
Fluticasone inh may also cause
Eosinophilia, pulmonary > neuropathy sinusitis, cardiac
Usually purpuric lesions of the lower legs
LCV with eos
P ANCA maybe positive
May be caused by unopposed B4 activity

114

Injected steroids

May migrate along lymphatics and cause linear atrophic hypopigmented hairless streaks

Use TAC acetonide, not hexacetonide