Dermatological

Drug Reactio

nsA Razzaque

Ahmed MD, DScarahmedmd@m

sn.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

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

Exanthematous Drug Eruptions

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 hydrochlorothiazide

Drug Induced Vasculiti

s

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(trimethoprim-sulfamethoxazole)

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 Epiderm

al Necrolys

is

Oral and Ocular

presentation of Stevens-

Johnson Syndrome

Stevens-Johnson 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 5-fluorouaracil

Cutaneous side effects of chemotherapy:Erythema of the ears due to cytaribine(cytocine 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