1) Drug eruptions are unwanted, harmful skin effects caused by drugs and can include rashes, blisters, and hives. 2) There are several types of drug eruptions such as severe life-threatening eruptions like Stevens-Johnson syndrome, exanthematous eruptions which cause red macules on the body, and photosensitivity rashes caused by drugs like tetracycline. 3) Urticaria, commonly known as hives, causes wheals or swollen bumps on the skin that are usually itchy and come and go rapidly, and can sometimes involve angioedema which is swelling under the skin of the face, lips, tongue, and

1. DR. BIJAY KR.YADAV
Holly vision technical campus
Shankhamul, Kathmandu

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”

7. Urticaria / Angioedema
Classification
 Acute
 < 6 weeks duration
 Chronic
 > 6 weeks duration
 Idiopathic – as much as 70%
 Autoimmune
 Urticarial vasculitis

8. The main types of Urticaria :
1. Physical
 Cold
 Soalr
 Heat
 Cholinergic
 Dermographism (Immediate pressure urticaria)
 Delayed pressure
2. Hypersensitivity
3. Autoimmune
4. Pharmacological
5. contact

9. Causes :
1. Endogenous cause :
 Infection
- Bacterial
- Viral ( Hepatitis, HIV infection during seroconversion etc )
- Mycoplasma
- Intestinal parasites
 Connective tissue disorder
 Hypereosinophilic syndrome
 Hyperthyroidism
 Cancer
 lymphomas

10. 2. Exogenous cause :
 Drugs both systemic & topical
 Foods & food additives
 Bites
 Pollens
 Insects venoms
 Inhalants
 Animal dander

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

14. Treatment :

15. THANK YOU