Contact Dermatitis/ Drug Eruptions Flashcards
(114 cards)
1
Q
Produces parasthesias of fingertips, cyanosis, gangrene
A
Oxalic acid
Neutralized by limewater or milk of magnesia
2
Q
Produces a white eschar
May cause glomerulonephritis or arrythmias
A
Phenol (carbolic acid)
Neutralized by ethyl or isopropyl alcohol
3
Q
Hydrofluoric acid
A
Neutralize periungual burns with IL calcium gluconate
May cause low Ca, low Mg, high K and dysrrythmias
4
Q
Lime, arsenic, zinc dust
A
May produce folliculitis
5
Q
Hyperpigmentation, keratoses, scrotal cancer
A
InSoluble cutting oils
6
Q
Acne corne
A
Follicular keratosis and pigmentation from crude petroleum
7
Q
Acquired perforating dermatosis in field workers
A
Calcium chloride
8
Q
Inhalation causes exfoliative erythroderma, eosinophilia, mucous membrane erosions and hepatitis
A
Trichloroethylene used as degreasing agent and dry cleaning
9
Q
Contact urticaria
A
Cetyl amd stearyl alcohol
10
Q
Produce a pustular eruption on patch testing of no clinical significance
A
Nickel, mercury, potassium iodide
11
Q
Other toxicodendron reactors
A
Cashew (nutshell), rengas tree, spider flower, silver oak
12
Q
Rescorcinol allergy
A
Person is elliptical, wheat bran, marine brown algae
13
Q
Prevents or diminishes poison ivy
A
Quaterinium 18 bentonite
14
Q
Sites of early mango dermatitis
A
Eyelids and prepuce bc from palms
15
Q
Ingestion of ginkgo fruit results in
A
Perianal dermatitis
16
Q
Most common cause of allergic dermatitis in florists
A
Peruvian lily
17
Q
Antigenic site of sesquiterpene
A
Alpha methylene portion
18
Q
Causes a severe inflammatory bullous rxn
A
Prairie crocus
19
Q
Contact urticaria and anaphylaxis
A
Onion and celery
20
Q
Cause erythema multiforme
A
Tea tree oil, cocobolo, rosewood (exotic woods), Bermuda fire sponge
21
Q
Seaweed dermatitis
A
Blue green algae (lyngbya), within minutes, area covered
22
Q
Sabra dermatitis
A
Prickly pear and fig
Resembles scabies
23
Q
Pastry baker hand dermatitis
A
Cinnamon
24
Q
Dentist dermatitis
A
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
