Dermatological Drug Reactions ARazzaqueAhmedMD,DSc arahmedmd@msn.com
DISCLOSURE •“IMANA is committed to providing CME activities that are fair, balanced, and free of bias. Full and specific disclosure information is provided in your handouts.” • •I have no relevant financial relationship(s) with any commercial interest.
• Skin – one of the most common target organs • Observed in 0.1-1.0% of pts. in pre-marketing trials • Approximately 2% are considered serious by WHO • 1 of every 1000 hospitalized patients (Rougeau)
Epidemiology • Responsible for approx. 3% of injuries during hospitalization • 2% of Derm consults in the hospital • Incidence of fatalities 0.1-0.3% • Women more susceptible • Incidence increases with age • Atopic Diathesis risk factor
Exanthematous Drug Eruptions A. Numerous pink papules on the trunk due to cephalosporins B. Confluence of lesions on the trunk C. Annular plaques on the forehead due to phenobarbital
Urticaria
Urticaria
Angioedema: Due to amoxicillin
Morbilliform Maculopapular Eruption: Most common drug reaction
Morbilliform Maculopapular Eruption: Most common drug reaction
Phototoxic reaction in a patient receiving methotrexate: The erythema and blister are limited to sun exposed sites and resemble and exaggerated sunburn
Photolichenoid drug eruption due to
Drug Induced Vasculitis
Fixed Drug Eruption: Well demarcated erythematous plaque due to phenophthalein
Fixed Drug Eruption: Violet to brown plaque due to naproxen
Fixed Drug Eruption: Central erosion due to ciprofloxacin
Fixed Drug Eruption: As lesions heal, circular areas of hyperpigmentation are commonly seen (trimethoprimsulfamethoxazole)
Fixed Drug Reaction
Sweet’s Syndrome (acute febrile neutrophilic dermatosis)
Sweet’s Syndrome (acute febrile neutrophilic dermatosis)
Local reaction due to Vitamin K injection
Iododerma: Edematous erythematous papules on the buttocks with central crusts
Drug Rash with Eiosinophilia and Systemic Symptoms (DRESS): Edema of the face as well as edematous pink papules in this woman who had taken carbamazepine
Linear IgA Bullous Dermatosis
Drug Induced Bullous Pemphigoid
Toxic Epidermal Necrolysis
Oral and Ocular presentation of Stevens-Johnson Syndrome
StevensJohnson Syndrome: Target lesions
Heparin Induced Necrosis
Heparin Induced Necrosis
Cutaneous side effects of chemotherapy: Ulceration due to extravasation of doxorubicin
Cutaneous side effects of chemotherapy: Hozizontal melanonychia due to 5fluorouaracil
Cutaneous side effects of chemotherapy: Erythema of the ears due to cytaribine(cytocin e arabinoside)
Cutaneous side effects of chemotherapy: Eyrthrodysesthesia due to cytarbine with obvious erythema of the plantar surface
Cutaneous side effects of chemotherapy: Necrosis of psoriatic plaques due to an ‘”overdose” of methotrexate
Cutaneous side effects of chemotherapy: F. Raynaud’s phenomenon and digital necrosis due to systemic bleomycin
Gray discoloration of the face due to amiodarone: Biopsy specimen demonstrates yellow brown granules within dermal macrophages
Skin hypopigmentation due to cleaning agents
DISCLOSURE NO CONFLICT OF INTERESTS OR FINANCIAL RELATIONSHIPS TO DISCLOSE.
Thank You