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Dermatology > Cutaneous Drug eruptions > Flashcards

Cutaneous Drug eruptions Flashcards

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1
Q

What kind of reactions are pemphigus and pemphigoid?

A

Type II

Cytotoxic reactions

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2
Q

What would you see in a type I immune reaction?

A

Urticaria

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3
Q

What would you see in a type III immune reaction?

A

Pupura/rash

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4
Q

What would you see in a type IV immune reaction?

A

erythema/rash

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5
Q

What are the risk factors for drug eruptions?

A 
Age
Gender
Genetics 
Concomitant disease
Immune status
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6
Q

Which age groups are more likely to get drug eruptions?

A

young adults > infants/elderly

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7
Q

What gender are more likely to get drug eruptions?

A

Females

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8
Q

Which concomitant diseases raise the chance of getting a drug eruption?

A

Viral infection (HIV/EBV/CMV)

Cystic fibrosis

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9
Q

What are the risk factors for drugs involved in eruptions?

A

Chemistry
Route
Dose
Kinetics/half life

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10
Q

What drugs Chemistry makes them likely to cause an eruption?

A

B lactic compounds, NSAIDs

High molecular weight, hapten forming drugs

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11
Q

What is the most common type of drug eruption?

A

Exanthematous drug eruption

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12
Q

What kind of reaction is an exanthematous drug eruption?

A

idiosyncratic, T-cell mediated delayed type hypersensitivity (IV) reaction

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13
Q

What is seen in an Exanthematous drug eruption?

A

Widespread, symmetrically distributed rash,

itch is common, mucous membranes spared

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14
Q

How quick is onset of an exanthematous drug eruption?

A

4-21 days after onset of drug

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15
Q

What is the danger with exanthematous drug eruptions?

A

It can progress to a severe life threatening reaction

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16
Q

What would indicate a potentially severe exanthematous drug eruption?

A
  • Involvement of the mucous membranes and the face
  • facial erythema and oedema
  • widespread confluent erythema
  • fever >38.5
  • skin pain
  • blisters, purpura, necrosis
  • lymphadenopathy, arthralgia
  • SOB, wheezing
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17
Q

What drugs are associated with exanthematous eruptions?

A
  • Penicillins
  • Sulphonamides
  • erythromycin
  • allopurinol
  • anti-epileptics; carbamazepine, phenytoin
  • NSAIDs
  • chloramphenicol
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18
Q

What are the two mechanisms of urticarial drug reactions?

A

Usually IgE mediated type I after rechallenge with drug
OR
Direct release of inflammatory mediators from mast cells on first exposure

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19
Q

Which drugs cause urticarial drug reactions by direct release of inflammatory mediators from mast cells?

A 
Aspirin
Opiates
NSAIDs
Muscle Relaxants
Vancomycin
Quinolones
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20
Q

What may urticarial reactions be associated with?

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A

Angioedema or anaphylaxis

21
Q

Which drugs cause acneiform drug reactions?

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A

Glucocorticoids

Androgens, lithium, isoniazid, phenytoin

22
Q

Which drugs cause generalised exanthematous pustulosis (AGEP)

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A

Antibiotics, CCB, antimalarials

23
Q

What drugs can induce bullous pemphigoid?

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A

ACE inhibitors, penicillin, furosemide

24
Q

What drug can trigger linear IgA disease?

25
What is seen in a fixed drug eruption?
Well demarcated round/ovoid plaques Red, hands, genitalia, lips, occasionally oral mucosa Can present as eczematous lesions, papule, vesicles or urticaria
26
How do fixed drug eruptions resolve?
Persistent pigmentation when drug stopped
27
What is significant about fixed drug eruptions?
Can re-occur at same site on re-exposure to drug
28
What drugs are associated with fixed drug eruptions?
Tetracycline, doxycycline Paracetamol NSAIDs Carbamazepine
29
Name some severe cutaneous adverse drug reactions?
Stevens-johnson syndrome (SJS) Toxic epidermal necrolysis (TEN) Drug reaction with eosinophilia and systemic symptoms (DRESS) Acute generalised exanthematous pustulosis (AGEP)
30
What drugs can cause SJS or TEN?
Sulfonamides, cephalosporins, carbamazepine, phenytoin, NSAIDs, nevi rapine, lamotrigine, setraline, pantoprazole, tramadol
31
What drugs can cause DRESS?
Sulfonamides, anticonvulsants, allopurinol, minocycline, dapsone, NSAIDs, abacavir, nevirapine, vancomycin
32
What are the acute phototoxic drug reactions?
Skin toxicity- photosensitivity Systemic toxicity Photodegradation
33
What are the chronic phytotoxic drug reactions?
Pigmentation Photoageing Photocarcinogenesis
34
What is the mechanism of phytotoxic cutaneous drug eruptions?
Non-immunological skin reaction arising in an individual exposed to enough photo-reactive drug and light of the appropriate wavelength
35
What usually causes phototoxic cutaneous drug reactions?
Usually UVA/visible light eg. through window glass
36
What other mechanisms aside from drug use can cause increased sensitivity to sunlight?
Immunosuppression Lupus
37
What drugs present with immediate prickling with delayed erythema and pigmentation?
Chlorpromazine | Amiodarone
38
What drugs present with exaggerated sunburn?
Quinine Thiazides Demeclocycline
39
What drugs present with exposed telangectasis?
Calcium channel antagonists
40
What drugs present with delayed 3-5 days erythema and pigmentation?
Psoralens
41
What drugs present with increased skin fragility?
Naldixic acid, tetracycline naproxen, amiodarone
42
What drugs are common culprits of photosensitivity?
Doxycycline Amiodarone Chlorpromazine Quinine
43
What does PPI induced photosensitivity present as?
Sub-acute cutaneous lupus
44
What is photo testing done for?
suspected phototoxic drug reactions
45
What are biopsies taken for
identifying the type of drug reaction and exclusion of other diseases
46
What are patch and photo patch tests used for?
suspected allergic contact dermatitis (type IV)
47
What are skin prick/intradermal tests for specific drugs useful for?
Suspected allergic reactions (Type I)
48
What is skin testing not indicated for?
Serum sickness reactions (type III) or for cell mediated (type IV) reactions or for those with severe cutaneous adverse drug reactions
49
What are the best management options?
- Discontinue drug and use alternative - Topical corticosteroids - antihistamies if type I ot itch - use of allergy bracelet

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