Cutaneous Adverse Drug Rxns & Cutaneous Carcinoma Flashcards by TRISHA JOY BASILLE RODRIGUEZ

What are the 4 main catgories of Cutaneous drug reactions?

Exanthematous/Morbilliform
Urticartial
Fluid-filled lesions/Blistering
Pustular

How well did you know this?

Not at all

Perfectly

What are causes of non-immunologic CADRS?

Idiosyncrasy
Cumulation
Pharmacologic adverse event
Induction or exacerbation of a disease
Cumulative toxicity

How well did you know this?

Not at all

Perfectly

What can CADR can be exacerbated due to chronic intake of oral steroids?

Pustular psoriasis

How well did you know this?

Not at all

Perfectly

What is a CADR of Isoniazid?

Isoniazid-induced acne

(Used to tx pumonary TB)

How well did you know this?

Not at all

Perfectly

What is a CADR of Clofazimine?

Clofazimine-induced hyperpigmentation

(Tx for leprosy; slate gray hyperpigmentation on the face & trunk)

How well did you know this?

Not at all

Perfectly

What is a CADR of taking HIV drugs?

Lipodystrophy

(Loss of fat in the cheeks)

How well did you know this?

Not at all

Perfectly

What are the 2 classifications of CADRS?

Imemdiate reactions
Delayed reactions

How well did you know this?

Not at all

Perfectly

How to do you classify CADR as an immediate reaction?

Within 6 hrs or occurs within 30 mins from lat administered dose

How well did you know this?

Not at all

Perfectly

How do you classify it as a delayed reaction of CADRS?

> 6 hours and occassionally weeks to months after start of administration

How well did you know this?

Not at all

Perfectly

What is our approach to patients with CADRS?

“RASH”
Remember
Appearance
Systemic featuers
Histology

How well did you know this?

Not at all

Perfectly

What are the lab tests ordered for CADRS?

CBC
Drug testing (if assoc with overdosage)
Liver & Kidney FTs

How well did you know this?

Not at all

Perfectly

What is the preferred method of evaluation of possible type 1 IgE-mediated penicillin allergy

Penicillin skint test

How well did you know this?

Not at all

Perfectly

What are the 2 types of localized CADRs?

Fixed drug eruptions
Irritant/allergic contact dermatitis

How well did you know this?

Not at all

Perfectly

What type of localized CADR presents as erythmetaous or violaceous slitary macule, patch, or plaque that recurs at the same site?

Fixed drug eruptions

(Develops 30mins-8hrs after drug intake)

How well did you know this?

Not at all

Perfectly

What are medications that cause fixed drug eruptions (FDE)?

Tetracycline
Metronidazole
Sulfonamides
NSAIDs

How well did you know this?

Not at all

Perfectly

What are the management options for FDR?

Drug withdrawal
Topical steroids
Pain meds, wound care
Topical antibiotics if eroded

How well did you know this?

Not at all

Perfectly

What is the diff betw irritant contact dermatitis & allergic contact dermatitis?

Irrirtant contact dermatitis = well-demarcated & localized areas of thin skin

Allergic contact deramtitis = linear or angular lesion

How well did you know this?

Not at all

Perfectly

What are the common irrirtans causing irritant CD?

Chronic wet work
Soaps
Detergents

How well did you know this?

Not at all

Perfectly

What aer the 5 generalized cutaneous ADRs?

Urticaria/angioedema
Exanthematou Morbilliform drug eruption
Drug-induced hypersensitivity syndrome
Acute generalized exanthematous pusulosis
Steven johnsons syndrome & Toxic epidermal necrolysis

How well did you know this?

Not at all

Perfectly

What are common causes of Urticaria/Angioedema CDRs?

Drugs: ACE inhibitors, penicillin, NSAID, opiates, conrtast dyes

Blood products
Idiopathic

How well did you know this?

Not at all

Perfectly

What are DOC for urticaria CDR?

Antihistamines

How well did you know this?

Not at all

Perfectly

What is the management of angioedema CDR?

IV antihistamine or epinephrine
Steroids

How well did you know this?

Not at all

Perfectly

What is the most common type of cutaneous drug rxn that appears 4-14 days after intake of drug?

Exanthematou/morbilliform drug eruption

How well did you know this?

Not at all

Perfectly

What are the common meds that cause Exanethamatous drug eruption (EDE)?

Penicillin
Cephalosporin
Sulfonamides
NSAIDs
Anticonvulsants

How well did you know this?

Not at all

Perfectly

What are the clinical manifesation of drug-induced hypersensitivity syndrome (DIHS)?

Systemic symptoms Lymphadenopathy Rash Systemic & organ involvement

What are the common meds causing DIHS?

Allopurinol Antibiotics Anticonvulsants Isoniazid NSAID

What generalized cutaneou ADR has small non-follicular pustules on an erythematous based on the trunk & extremities?

Acute generalized exanthematous pusulosis (Appears 48 hrs after drug intake)

What are the clinical manifestations of AGEP?

- fever, malaise, lymphadenopathy, & abrupt pustular lesions - systemic involvement in 20% of the patients (hepatocellular dysfunction & nephritis)

What is a dermatologic emergency that presents with acute life-threatening mucocutaneou rxns?

Steven johnson syndrome (SJS) or Toxic epidermal necrolysis (TEN)

What are the common causes of SJS & TEN?

Viral infection OR Mycoplasma

What are the clin manifestations of SJS/TEN?

(+/-) Prodromal symptoms: Fever, sore throat Tender, erythematous skin or mucosa Detachment of epidermis, cutaneou & mucosal exfoliation (+/-) multisystemic involvemenet: bronchitis, GIT ulcers, hepatitis, nephritis

What aer the course of clinical presentation?

Prodrome: fever, malaise, cough, headache 1-3 days before skin eruption: mucosal involvement 1-4 weeks: erythema & skin tenderness Vesicles & bullae Erosions and exfoliation

What are the common medications that cause SJS/TEN?

“SANTAN” Sulfonamides Allopurinole NSAIDs Tetracyclines Anticonvulsants Nevirapine

What are atnihistamines given in cutaneou DRs?

1st gen H1 antihistamines = sedating 2nd gen H1 antihistamines = less sedating

Is there tx required in benign cutaneou tumors?

What are the management options for benign cutaneou tumros?

Electrodessication & curettage CO2 laser Cryotherapy Excision

What are the diff Benign Cutaneous Tumors?

Sebaceous gland hyperplasia Milium Syringoma Common acquired melanocytic nevi Seborrheic keratosis Keratocanthoma

What is the more common benign cutaneous lesions found in px with oil skin and presents with yellowish, flesh-colored smooth appules with a central umbilication or dell?

Sebaceous gland hyperplasia (Found @ the forehead)

What is the clin feature of Milium?

1-2mm white to yellowish dome-shaped papules found at the eyelids & cheeks

What is the cause of Milium?

Eccrine duct plugging

What benign CDR is characterized by prolifeation of eccrine glands?

Syringoma (Tadpole-shaped strutures in the deep dermis)

What are the clin features of Syringoma?

Firm, smooth, skin-colored or slightly yellowish papules to plaques on the lwoer eyelids (Parang teardrops yung pattern niya)

What are collection of nevus cells and appears neat & symmetric, orderly or uniform with regular borders?

Common acquired melanocytic nevi

What aer the diff types of nevus?

Junctional nevus Compound nevus Intradermal nevus

What are the appearances of the diff types of nevus?

Junctional nevus = flat, hyperpigmented macule Compound nevus = tan, brown hyperpigmented papule or nodule Intradermal nevus = skin-brown colored papule or nodule

What is the most common benign epidermal tumor?

Seborrheic keratosis

What are the clin features of seborrheic keratosis?

- “stuck on” appearance - palms & soles - Leser-Trelat sign

What are the variants of Seborrheic keratosis?

Dermatosis papulosa nigra = found on thef ace Acrochordon = skin tags (neck, armpit)

What are etiologic factors of Keratoacanthoma?

- chronic UV light exposure - chemical carcinogens - smoking -trauma - Immunosuppression

what are the clin featuers of Keratoacanthoma?

Solitary tumor that rapidly grows within a few wks

What are the diff management of Keroacanthoma?

1st line = complelte surgical excision

What are the systemic associations of Keratoacanthoma?

Muir-Torre syndrome Hereditary nonpolyposis colorectal cancer syndrome Xeroderma pigmentosum Lymphomatoid papulosso

What are the diff malignant cutaneou carcinomas?

Squamous cell carcinoma Basa cell carcinoma Cutaneous melanoma

What are the dx tests of malignant cutaneous carcinomas?

Dermoscopy Punch biopsy - gold std for skin cancer

What are causes of SCC?

Bruns or long-term heat exposure Chronic scarring/inflammatory dermatoses

What are the clin features of SCC?

Solitary firm, flesh-colored or erythematous keratotic plaque or tumor

What are the diff management of SCC?

Non-excisional ablative therapy Conventional surgical excision MOH surgery

When do you use MOHS surgery?

If cutaneous carcinoma is at the high-risk mask area

When do you use conventional surgical excision in SCC?

Low risk SCC with a depth of <2mm

What gene causes BCC?

PTCH gene mutation

What aer the diff subtypes of BCC?

Superficial BCC Nodular BCC Pigmented BCC Morpheaform BCC

What are the clin featuers of BCC subtypes?

Nodular BCC (most common) = translucent, telangiectasia Pigmented BCC = hyperpigmented, translucent or blackish plaque or papule

What are the management options for BCC?

1st = surgical removal

What is a highly aggressive malignant melanocytic tumor?

Cutaneous melanoma

What are the diff cutaneous melanoma??

Superficial spreading melanoma Nodular melanma Nevoid melanoma

What is the most common cutaneous melanoma w/ Erythemaous or pigmented plaque, bluish brown or skin-colored foudn at the back & LE?

Superficial spreading melanoma

What are the ABCDE assessment for skin?

Asymmetry Border Color Diameter (>5mm) Evolving

What type of cutaneous melanoma is uniformly dark blue-black or bluid red nodule, vertical growth & site is at the trunk?

Nodular melanoma

What is an important sign of cutaneous melanoma?

“Ugly duckling” sign = lesions diff from the rest of lesion or moles

Cutaneous Adverse Drug Rxns & Cutaneous Carcinoma Flashcards

(69 cards)