in cutaneous drug eruption

1. • Allupurinol
• Anti-HIV medication
• Penicillin
• NSAIDs
• Radiocontrast media
• Anti-convulsant
• Sulphonamide
• Vancomycin
• Cancer chemotherapy
• Glucocorticoids
• Biologic therapies
DRUGS OF
SPECIAL
INTEREST

2. › Uric acid reducing drug
› Tx of gout and renal calculi
› Effect :
– Mild maculopapular eruption
– Hypersensitivity reaction/DRESS (drug reaction with eosinophilia and
systemic symptoms)
– Stevens-Johnson syndrome (SJS) / toxic epidermal necrolysis (TEN)
Allupurinol (<1%)

3. › Abacavir
› 4-8% risk of hypersensitivity
› Effect :
– Type 1 (dyspnea, diarrhea,
hypotension, shock on
rechallenge)
– Delayed hypersensitivity (rash,
late onset of hepatitis)
– Lower risk in African
(HLAB*5701)
› Nevirapine
› High risk
› Effect:
– Maculopapular eruption
– SJS/TEN
– Increase dosage gradually
Anti HIV drug (>10%)

4. › Β-lactam antibiotic (bactericidal)
› For gram +ve organism
› Effect
– Cutaneous : Morbilliform, urticarial, angioderma (Due to IgE
deposition)
– Delayed reaction : Maculopapular reaction
Penicillin (1%)

6. › Aspirin (Salicyclates) – COX inhibitor
› Effect :
– Urticaria/angioderma (24 hours)
– Rhinosinisitis-asthma syndrome (an hour)
– Phototixicity
– Pseudoporphyria (Naproxen)
– DRESS (COX-2 inhibitor, oxicam derivatives)
– SJS/TEN (oxicam derivatives, phenylbutazone)
NSAID (1%)

7. › Used to improve the visibility of internal bodily structures in X-
ray-based imaging techniques such as computed tomography
(CT), radiography, and fluoroscopy.
› Mostly : Iodine and Barium
› High-osmolality (ionic)
› Effect :
– Uriticaria
Radiocontrast Media

8. › Phenobarbitol, carmabazepine, phenytoin, lamotrigine
› Common in Chinese Han (HLA association)
› Effect : SJS, TEN
› Safest : Lamotrigine
Anticonvulsant

9. › Bactericidal antibiotic (gram +ve
organism)
› Effect :
– Linear IgA bullous dermatosis
– Red man syndrome (on rapid IV)
– Histamine related anaphylactoid reaction
(flushing, diffuse maculopapular eruption,
hypotension, cardiac arrest)
Vancomycin

10. › Antibacterial
› sulphamethoxazole +trimethoprim (eruption at higher rate)
› Effect :
– Cutaneous eruption
– SJS
– TEN
Sulphonamide

11. › Side effect : Alopecia, stomatitis, nail abnormalities, sterile
cellulitis
› Acral erythema (doxorubicin, methotrexate, hydroxyurea, 5-
fluorouracil) – (Tx : pyridoxine)
› Ig E mediated, ARDS, hypotension (Cisplastin) –(Tx: H-blocker)
› Follicular eruption, nail toxixity (Cetuximab) –(Tx : antibiotic)
Cancer Chemotherapy

12. › Cushing’s : Acneiform eruption, atrophy, striea
› High doses : Slow wound healing
› Allergy : Contact dermatitis
Glucocorticoids

13. › Cytokines, cytokines antagonist, monoclonal antibodies
› Injection site : redness and necrosis
› Monoclonal ab : urticaria, angioderma, anaphylactic reaction,
serum sickness.
› INF- : alopecia, pruritic dermatitis
› Granulocyte colony-stimulating factor : neutrophilic
dermatoses, sweet’s syndrome, pyoderma gangrenosum,
psoriasis.
Biological Therapy

14. › Acute febrile
neutrophilic
dermatosis
Sweet’s syndrome

15. › Used for tx of several skin dz, but also can induce one
› Black pigmentation of face, mucous membrane, pretibial and
sublingual
› Effect :
› Pruritus (Chloroquine)
› Generalized yellow discolouration (quinacrine)
› Pustules (AGEP)
› DRESS
Antimalarial agent

16. Prepared by NZareef~
THANKS