This document discusses different types of cutaneous drug eruptions including exanthematous drug eruptions, urticaria and angioedema, fixed drug eruptions, erythema multiforme, and Stevens-Johnson syndrome and toxic epidermal necrolysis. Exanthematous drug eruptions present as symmetric macules and papules on the trunk and extremities within 3 weeks, while urticaria and angioedema cause transient wheals and edema. Fixed drug eruptions result in solitary or multiple plaques or erosions that recur in the same site with repeat exposure to the causative drug. Erythema multiforme presents as stable circular erythemas or ur

1. Cutaneous Drug
Eruptions

2. Exanthematous Drug Eruptions
Characterized by a cutaneous
eruption that mimics a viral
exanthem.
 Penicillin and related antibiotics
are by far the commonest causes.
Almost all dugs can cause it.
Pathogenesis unknown

3. Exanthematous Drug Eruptions
 Symmetric macules and/or papules, a
few millimeters to 1 cm in size are
seen almost always on trunk and
extremities with in three weeks
 More severe and common in all
patients having EBV or CMV infection

8. Exanthematous Drug Eruptions
 Urticaria, facial edema, blisters, mucosal
involvement, ulcers, palpable or extensive
purpura, fever, lymphadenopathy are
indications to dc the drug.
 Eruption usually recurs with rechallenge

9. Urticaria and Angioedema
 Transient wheals and larger edematous
areas that involve the dermis and
subcutaneous tissue.
 May be accompanied by anaphylaxis, and
laryngeal edema
 It is the result of immediate HR
 Penicillins and cephalosporins are common
causes.

19. Urticaria and Angioedema
 Antihistamines
 Steroids
 Adrenaline
 Resolves within hours to days to weeks
after the causative drug is withdrawn.

20. Fixed Drug Eruption
 Characterized by the formation of a
solitary, but at times multiple, plaque,
bulla, or erosion that occurs at the same
site when ever the drug is taken next time
 Sulfonamides and Tetracyclines are
commonly implicated
 Pathogenesis is unknown.

26. Fixed Drug Eruption
 The persisted hyperpigmentation is a
challenge for treatment.

27. Erythema Multiforme
 Stable circular erythemas or urticarial
plaques with areas of blistering and
necrosis and/or resolution in a
concentric array.
 Vaused by HSV and drugs.
 Due to type IV HR.
 May be extensive with mucosal
involvement.

34. Erythema Multiforme
 Regresses spontaneously within about 2
weeks.
 Like other reactions, the drug should not
be given again

35. SJS – TEN
 SJS is considered by most a maximal
variant of erythema multiforme and TEN a
maximal variant of SJS
 EM- Only target lesion
 SJS - 10 % epidermal detachment
 SJS/TEN OVERLAP - 10 % to 30 % epidermal
detachment
 TEN - 30 % epidermal detachment
 Increased incidence in HIV

36. SJS – TEN
 Cause may not be identified – idiopathic
 Begins suddenly with a nonspecific
prodromes
 Sheets of necrotic epidermis slide off the
face and at pressure points
 Internal organs may be involved

45. SJS – TEN
 Treated like burn patients
 MR increases with degree of epidermal
necrosis