2.medikamentozni egzantemi.ppt

7/27/2019 2.Medikamentozni egzantemi.ppt

1/67

drug eruptions


2/67

are common.

may be fatal.


3/67

I will present

1. approach

2. FDE - EM - TEN


4/67

steps

of

ap

pro

ach

steps

of

ap

pro

ach

morphological

non-drughistory

lists

elimination

symptomatic

skin testsprovocation

prohibition

morphological diagnosis

non-drug causeshistory

lists

elimination

symptomatic therapy


prohibition


5/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition

maculopapularrash

is the mostcommon form.maculopapular

rash


6/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition

urticariais the secondmost common

form.

urticaria


7/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition

lichenoideruption

may continue

for monthsafter the stop

of the drug.

lichenoideruption


8/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition

acneiformeruption

this patient was

using cortisonefor post-traumatic

cerebral edema.

acneiform lesionsoccurred

as a side effect.


9/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition

erythemanodosum

oral

contraceptivesmay be

the cause.

erythemanodosum


10/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition

iododermais characterizedby vegetations.

iodide is presentin cough

remedies.

iodide is used as

an intravenousradiocontrast

media.

iododerma


11/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition

any

elemantary lesion

anydistribution

any

course

cutaneous sideeffects of drugs

may simulate

almost everyskin diseases.


12/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition

measles, rubella

etc. are alsomaculopapular

rashes.


13/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition

urticaria


14/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition

TBC, Behets

disease etc. alsocause erythema

nodosum.


15/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition

URI, TB, Behets

disease etc. alsocause erythema

nodosum.

non-drug causesshould be

excluded for the

diagnosis of drugeruption.


16/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition

be

patient

ask some drugsname by name

evaluate

time factors


17/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition

time factorsshould be

evaluatedvery

carefully.week0-1-2-3-4-5

cerebral trauma

phenytoin for the first timefor the first timefor the first time

rash

0


18/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition


evaluatedvery


cerebral trauma

rash

0

phenytoin

a drug, which has not been used

before, usually causes an

eruption after a sensitizationperiod of several weeks.


19/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition


evaluatedvery


pyelonephritis

bactrim

relapse

bactrim

rash

0


20/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition


evaluatedvery


pyelonephritis

bactrim

relapse

bactrim

rash

0

a drug, which has been used

before, usually causes an

eruption immediately .


21/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition


evaluatedvery

carefully.day0-1-2-3-4-5 daydayday

bactrim aspirin

rash

0


22/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition


evaluatedvery

carefully.day0-1-2-3-4-5

bactrim aspirin

urticaria

0

if the eruption is urticaria, only

aspirin is the culprit, because

urticaria occurs within a day afterdrug intake.


23/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition


evaluatedvery

carefully.day0-1-2-3-4-5

bactrim aspirin

maculo-

papular

0

if the eruption is maculopapular,

both drugs are the culprit,

because maculopapular rash maydelay for several weeks.


24/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition


evaluatedvery

carefully.mo.0-1-2-3-4-5 mo.mo.mo.

captopril

angio-

edema

0


25/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition


evaluatedvery

carefully.mo.0-1-2-3-4-5

captopril

angio-

edema

0

a drug, which has been used

safely for months even years, may

also cause a cutaneous sideeffect.


26/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition


evaluatedvery


ampicillinpreviouslysafeampicillinpreviouslysafeampicillinpreviouslysafe

uri

ampicillin

rash

0


27/67

morphological

non-drughistory

lists

elimination

symptomatic


prohibition


evaluatedvery


safe

uri

ampicillin

rash

0

ampicillin, which has been used

safely before, may cause a rash in

the presence of infectiousmononucleosis.


28/67

morphological

non-drughistory

lists

eliminationsymptomatic


prohibition

thousands of

drugs

hunderds ofrash types

no oneremember

all of them !


29/67

morphological

non-drughistory

lists



prohibition

thousands of

drugs

hunderds ofrash types

no oneremember

all of them !

a guide, which

contains previousexperiences,

should be used.


30/67

morphological

non-drughistory

lists



prohibition

textbook

prospectus

internet


31/67

morphological

non-drughistory

lists



prohibition

treatment

=cessationof drugs


32/67

morphological

non-drughistory

lists



prohibition

treatment

=cessationof drugs

all non-vital drugs

should be

stopped !


33/67

morphological

non-drughistory

lists



prohibition

if angioedema

occurs in a patientwho is using

vitamins,

even if there is an

evident non-drug

cause of urticaria,

all drugs should

be stoppedbecause of risk of

laryngeal edema.


34/67

morphological

non-drughistory

lists



prohibition

do not say to a

patient that we

have stopped

all of yourdrugs. that is

the wholetreatment.


35/67

morphological

non-drughistory

lists



prohibition

drugs for

symptomatic relief

should be prescribedaccording to the

morphologicaldiagnosis.


36/67

morphological

non-drughistory

lists



prohibition

do not give an

order like that

in ject oneampu le of

cor t isone.


37/67

morphological

non-drughistory

lists



prohibition

precise

diagnosis

=rechallengewith drugs

one by one


38/67

morphological

non-drughistory

lists



prohibition

precise

diagnosis

=rechallengewith drugs

one by one

if there is risk fordeath,

provocation

should not bedone !


39/67

morphological

non-drughistory

lists



prohibition

indirect

diagnosis

prick-patchtests


40/67

morphological

non-drughistory

lists



prohibition

prick test detects

type I allergy to a

given substance.

prick test is

useful inurticarial

rashes.


41/67

morphological

non-drughistory

lists



prohibition

patch test

detects type IVallergy to a given

substance.

patch test is

useful inmaculopapular

rashes.


42/67

fixed drug eruption,erythema multiforme and

toxic epidermal necrolysiswill be briefly discussed in

the rest of the presentation.

fi d d ti


43/67

fixed drug eruption

main elementary lesions are

round erythematous macules.

fi d d ti


44/67

fixed drug eruption

these erythematous macules

leave hyperpigmentation.

fi d d ti


45/67

fixed drug eruption

if the responsible drug is used

again, the macules redden.

fi d d ti


46/67

fixed drug eruption

blisters may develop on the

active lesions.

fi d d ti


47/67

fixed drug eruption

glans penis is commonly

involved.

fi d d ti


48/67

fixed drug eruption

an erosion occurs after rupture.

it may look like a chancre.

fixed drug eruption


49/67

fixed drug eruption

an erosion occurs after rupture.

it may look like a chancre.

remnants of bullaeindicates fixed eruption;

induration, syphilis.palpation should be done

with gloves !

erythema multiforme


50/67

erythema multiforme

in the minor form

macules and papules,

erythema multiforme


51/67

erythema multiforme

in the major form

bullae dominate.

erythema multiforme


52/67

erythema multiforme

especially acral regions

and

erythema multiforme


53/67

erythema multiforme

periorificial regions are involved:

mouth, eye, anogenital region.

erythema multiforme


54/67

erythema multiforme

erythematous rings

with different hues

erythema multiforme


55/67

erythema multiforme

target lesion

is pathognomonic.

erythema multiforme


56/67

erythema multiforme

target lesions are seen both in

minor and major forms.

erythema multiforme


57/67

erythema multiforme

erythema multiforme may

also be due to infections,especially herpes simplex.post-herpetic EM usually

has a recurrent course.

erythema multiforme


58/67

erythema multiforme

Stevens-Johnsonsyndrome

bullae + mucosal lesions + fever

erythema multiforme


59/67

erythema multiforme

there are sores

in the mouth and eyes.

toxic epidermal necrolysis


60/67




61/67


there are generalized bullae and

widespread erosions.



62/67


it looks like staphylococcal

scalded skin syndrome.



63/67


targetoid and mucosal lesions are

usually enough for differentiation.



64/67


a biopsy should be done

in doubtful cases.



65/67


it is treated like a burn.



66/67


unfortunately, the mortality rate

is almost 50%.

maculopapular rash


67/67

maculopapular rash,

which is the mostcommon form of drug

eruptions, may progressto toxic epidermal

necrolysis, if thecausative is not stopped.

2.medikamentozni egzantemi.ppt

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