2. Drug eruption
Drug eruption or Drug reaction : are the unwanted, harmful & adverse
effects of the drugs in the body organs. Skin disorder are the frequent
form of drug side effect.
Types of drug eruption :
1. Severe life threating eruption
a. Angioedema / Anaphylactic shock ( IgE mediated reaction)
b. Erythema multiformes & Stevens Johnson’s syndrome
( tocix Epidermal Necrolysis)
3. 2. Exanthematic eruption
Common type
Red / pink macules develop over
the trunk & limbs
a. A lichenoid rash ( similar to lichen
planus ) :- Carbamazipine
b. Vascular eruption :
- Develop over the legs & less
frequently over arms & trunk
- Thiazide, Diuretics
a. Urticarial rash : produced by
Penicillin, Aspirin
4. 3. Photosensitivity Rashes :
By solar ultraviolet spectrum - Red,
papules or plaque like rash
By drugs – like Tetracycline &
sulphonamides
4. Blistering rash :
- Furosemide, captopril, penicillamine,
Naproxen
5. Fixed drug eruption :
- Dapsone, Sulphonamide, Tetracycline
& Mefenamic acid
- The areas becomes inflammed & may
form blisters
6. Lupus erythematous
7. Hair & nail changes
5. Urticaria
Also known as Hives, Nettle-rash
Rapid appearance of wheals which may be accompanied by
angioedema
A wheal consists of 4 typical features:
1. swelling of variable size, surrounded by a reflex erythema
2. Pruritic (itch!)
3. Blanche with pressure
4. Fleeting (“Leaves no trace”)
-No scarring
6. Angioedema
Sudden, pronounced swelling of the lower dermis and subcutis
Sometimes painful rather than itching
Frequent involvement of mucous membranes
Resolution is slower than for wheals and can take up to 72 hours
1. Non-pitting edema
2. SkiNon-dependent areas
It is not: “pre-tibial pitting edema”
11. Clinical features :
Sudden appearance of pink itchy wheals
Anywhere in the skin and each last for less than a day
Lesions may enlarge rapidly and some resolve centrally &
take annular shape
In acute anaphylactic reaction – wheals cover most of skin
surface
In chronic urticaria – only few wheals develop every day
12. Complications
1. Anaphylactic reactions with laryngeal edema and
asphyxiation ; edema of tracheobronchial tree leading to
Asthma.
2. Interference with sleep due to itching
3. Sedation due to antihistamines.
13. Diagnosis
1. Is it urticaria ?? :
- evanescant &erythematous wheals
- lesions subside within 72 hrs leaving behind
normal skin
2. Which type of urticaria ?? -
History : hlo drug intake, any physical stimuli which
aggravate the urticaria, history suggestive of any
infection - Systemic review: to rule out an underlying
disease - Investigations : Routine screening
tests, diet elimination test, provocation of urticaria,
Autologous serum skin test (AAST)- done in
autoimune urticaria