Drug eruptions Is also called the great imitator

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Drug eruptions

Drug eruptions

Is also called” the great imitator” because they can simulate any skin disease, it

Is also called” the great imitator” because they can simulate any skin disease, it is more common in women than men, in elderly than young patients. Commonest drugs: - Anti-microbial - NSAIDS - Drugs acting on CNS

Clinical types 1 - Exanthematous: it is the most common type , sudden onset

Clinical types 1 - Exanthematous: it is the most common type , sudden onset of generalized erythematous maculopapular rash, ocurring 1 to 2 wks after drug adminstration, associated with fever & itching, usually last for 1 to 2 wks. Main drugs: penicillin, ampicillin & sulfa drugs

2 - Urticarial rash & angio-odema 3 - Serum sickness: Type III hypersensitivity reaction.

2 - Urticarial rash & angio-odema 3 - Serum sickness: Type III hypersensitivity reaction. Fever, joint pain, generalized lymphadenopathy sometimes haematuria & urticarial rash started 1 to 3 wks after drug intake. Main drugs: Penicillin & sulfa.

4 - Exfoliative dermatitis ( erythroderma): Generalized erythema & scaling involving more than 90%

4 - Exfoliative dermatitis ( erythroderma): Generalized erythema & scaling involving more than 90% of body surface, it may follow exanthematous rash. Mian drugs: sulfa. Antimalarial topical drugs: tar, sulphur

5 - Acneform rash: similar to acne, papules & pustules on the face &

5 - Acneform rash: similar to acne, papules & pustules on the face & trunk but no comedons or scarring i. e monomorphic rash main drugs: topical & systemic C/S anti-TB ( INH)

6 - Fixed drug eruption ( FDE) is rash which recur at the same

6 - Fixed drug eruption ( FDE) is rash which recur at the same site of skin each time when the same drug is administered i. e called FDE. Clinically the rash started few hrs after drug intake as a well-demarcated oval to round patch or plaque of dusky red erythema & odema & on the top of it there may be a large bullae. It usually healed with postinflammatory hyperpigmentation

Common sites: - male genitalia - oral mucosa - around eyes & mouth Offending

Common sites: - male genitalia - oral mucosa - around eyes & mouth Offending drugs : - sulfa - tetracycline - phenabarbitone

7 - eczematous 8 - Bullous DE : bullae are usually seen in: a-

7 - eczematous 8 - Bullous DE : bullae are usually seen in: a- FDE b- Drug-induced pemphigus : pencillamin captopril c- Erythema multiforme d- photo-toxic reaction

9 - Erythema multiforme: main drugs: sulfa, oral CCP 10 - Toxic Epidermal Necrolysis

9 - Erythema multiforme: main drugs: sulfa, oral CCP 10 - Toxic Epidermal Necrolysis (TEN) Is serious condition with high mortality rate. Patient presented with sudden onset of painful erythema started at body flexures & then become generalized. Peeling of the whole epidermis similar to 2 nd degree burn associated with fever & toxicity Offending drugs: sulfa, carbamazepine Treat: similar to burn prednisolone 40 -60 mg / day

11 - Erythema Nodosum (EN) inflammation of subcutaneous fat. Patient presented with painful &

11 - Erythema Nodosum (EN) inflammation of subcutaneous fat. Patient presented with painful & tender erythematous nodules on the anterior shins associated with fever & joint pain Commonest drugs: sulfa, CCP

12 - Lichenoid eruption: lichen planus like lesions Common drugs: B-blockers , thiazide 13

12 - Lichenoid eruption: lichen planus like lesions Common drugs: B-blockers , thiazide 13 - purpura: thrombocytopenic…. . Cytotoxic drugs increased BV fragility…. . C/Steroid vasculitis………………. . carbamazepine

14 - Hyperpigmentation: -post-inflammatory like in FDE - increased melanin synthesis…. CCP - Deposition

14 - Hyperpigmentation: -post-inflammatory like in FDE - increased melanin synthesis…. CCP - Deposition of drug material…. chloroquine tetracycline 15 - hypertrichosis: main drugs: steroid, cyclosporine

16 - Hair loss: anagen hair loss………cytotoxic drugs telogen hair loss……. CCP, thiouracil 17

16 - Hair loss: anagen hair loss………cytotoxic drugs telogen hair loss……. CCP, thiouracil 17 - Pityriasis rosea like: - gold therapy - captopril - mitronidazole

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