Drug Eruptions and photosensitivity rxns.txt

• 5% of all hospital admissions are for a drug reaction
• 15% of all hospitalized patients have one or more adverse reactions
• 1-3% derm related is unknown

error in prescribing or patient taking wrong dosage

• prematures
• jaundiced patient
• impaired renal function
• accumulative effect over many years

most common; probably some inborn predisposition

cholasma from birth control pills, or moniliasis from antibiotic therapy, psoriasis exacerbation from beta blockers, exacerbation of hives with ASA

flu-like symptoms appearing a few hours after treatment of any stage of syphilis

assumed drug induced, a vasculitis in the skin prepared by endotoxin from existing infection -examples of localized Schwartzman would be purpura fulminans and septicemia secondary to acute meningococcemia

• Type I
• Type II
• Type III
• Type IV

• Mast cell release of histamine, vasoactive amines, ECF-A, leukotrienes (SRSA), and platelet-
• activating factor

• 1. Hapten, Cocktail purpura, quiinine, Hemolytic anemia, penicillin
• 2. drug-antibody complexes, innocent bystander
• 3. Cross reacting antibodies, hemolytic anemia, a-methyldopa

Serum Sickness, vasculitis

drug-allergic contact dermatitis

• Age � more frequent in adults
• Sex � no difference
• Genetics � anaphylactoid reaction 2-3 times more common in atopic than non-atopic
• Disease - approximately 50% of patients with infectious mononucleosis given ampicillin will develop drug eruption � also ampicillin should not be given to patients with lymphatic leukemia or gout, especially if they are on allopurinol
• Administration � if allergic after parenteral injection, will also show allergy to oral administration
• Onset of reaction � may be in minutes as in anaphylaxis, or even weeks after being off medication
• Duration of sensitivity � unpredictable, so consider life long
• Chemical relatives or cross sensitization � examples -common para-amino ring, also systemic and topical relationship -example sulfa
• Drug interactions �example: anticoagulation and griseofulvin
• Teratogenic effects of drugs or their use in pregnancy -example: staining of teeth with tetracycline

immune complex disease produced by deposition of circulating immunecomplexes in skin, kidney, or other organ, usually requires six days to develop (penicillin, sulfonamides, thiorreol, dyes, dilantin, etc.)

common offenders are penicillin, cephalosporins, opiates, dyes used in diagnostic radiology, local anesthetics, etc.

morbilliform or measles about one week after starting drug � like: barbiturates, penicillin, sulfonamides, chlorothiazides, chlorpromazines, tranquilizers, gold, streptomycin, etc. (symmetric, trunk, areas of pressure)

bismuth, gold, barbiturates, etc.

occupational hazard of physician, dentist, veterinarians, nurses (para-amino group) penicillin, streptomycin, local anesthetics, phenothiazines, sulfonamides, quinacrine, gold, etc.

isoniazid, salicylic acid, and para-amino group meds, etc.

penicillin, sulfonamides, streptomycin, tetracycline, griseofulvin, barbiturates, phenothiazines, insulin, aspirin, opiates, dextrans, blood products, etc.

sharply delineated area of dermatitis recurring in same area on re-administration of drug, commonly occurring on buccal or genital mucosa, also palms and soles: phenolphthalein (Ex-Lax), antipyrine, salicylates, tetracycline, sulfonamides, barbiturates, quinine,vermouth, phenacetine, etc.

penicillin, sulfonamides, phenothiazines, bromides, salicylates, chlorpropamide, thiazides, herpes infections, etc.

allupurinol, measles vaccine, dilantin, sulfas, nonsteroidalantiinflammatory agents, fumigants, etc.

• penicillin, sulfonamides, birth control pills, salicylates, etc.
• Acneiform eruption
• bromides, iodides, corticosteroids, ACTH, cyanocobalamin, testosterone, antabuse, dilantin, INH, etc.

bromides, iodides, sulfonamides, phenylbutazone, mephenytoin, mercury, salicylates, phenolphthalein, etc.

salicylates, chlorothiazides, long-term steroids, ampicillin, carbamides, phenylbutazine, tolbutamide, meprobamate, anti-metabolites, sulfonamides, coumadin, etc.

arsenicals, barbiturates, mercurials, gold, phenylbutazone, quinicrine, penicillin, sulfonamide, phenothiazine, etc.

thiazides, gold, arsenic, chloroquine, quinicrine, quinidine, para-amino salicylic acid, beta blockers, etc.

gold, ACTH, Parkinson's disease, and meds for seizure disorders

• Examples:
• Sulfonamides
• Chlorothiazides

birth control pills, chlorpromazine, atabrine, chloroquine, bismuth, silver salts, minocyclin, etc.

Declomycin and others

chloroquine, quinacrine, etc.

anticoagulants (heparin), antimetabolites, alkylating agents, triparonol, beta blockers, etc.

arsenic (Fowler's solution)

hydralazine, mephenytoin, isoniazid, PAS, trimethadione, griseofluvin, procaineamides, etc.

cholestyranine, triparanol, butyrophenone, nicotinic acid, etc.

ACTH, testosterone

Corticosteroids, mercury, estrogenic hormones

• Sudden appearance
• Symmetrical
• Usually erythematous
• Minimal mucous membrane involvement
• Often involves palms and soles
• Laboratory tests � not very reliable

• Drug Incidence (%)
• Amoxicillin 5.1 Cotrimoxazole 3.4 Ampicillin 3.3 Corticotropin 2.8 Erythromycin 2.3 Chepholsporins 2.1 Semisynthetic penicillins 2.1 Cyanocobalamine 1.8 Sulfisoxazole 1.7 Gentamicin 1.6 Penicillin G 1.6 Atropine 1.6 Quinine 1.3

• Compound Found in:
• Ammonia Soaps, chemicals, hair dyes Balsam of Peru Cosmetics Benzyl alcohols Cosmetics, medications Caine anesthetics Sunburn products, medications Carba Rubber Chromium Jewelry Epoxys resins Glues Ethylenediamine Stabilizers, various, hair dyes Formaldehyde Shoes, clothes, soaps, insulation, carpet, building materials Mercaptobenzothiazole Rubber Naphthyl Rubber Neomycin Topical medications Nickel sulfate Jewelry, snaps, fasteners Parabens Preservatives, various Paraphenylenediamine hair dyes, leather Potassium dichromate Shoes, leather Thiomersal Preservatives, contact lens solutions Turpentine Paints Wool alcohols Lanolin containing products