cutaneous drug eruptions - gmch.gov.in lectures/pediatrics/scm cutaneous... · - steven-johnson...
TRANSCRIPT
CUTANEOUS
DRUG ERUPTIONS
CUTANEOUS DRUG ERUPTIONS
- Pruritus
- Fixed drug eruptions
- Urticaria
- Pigmentation
- Anaphylaxis
- Photosensitivity
- Steven-Johnson syndrome
- Purpura
- Toxic epidermal necrolysis
- Vasculitis
- Exanthematic rash
- Hair problems
- Exfoliative dermatitis
- Drug induced diseases
Fixed drug eruption
Urticaria
Pigmentation
Exanthematic Rash
Exanthematic rash
Photosensitivity
Erythema Multiforme
s
Stevens Johnson Syndrome
Stevens Johnson Syndrome
Toxic Epidermal Necrolysis
Toxic Epidermal Necrolysis
Exfoliative Dermatitis
Antibiotics
Penicillins - Exanthematic
Ampicillin
Cephalosporins - Exanthematic
Sulfonamides - FDE, SJS, TEN
Tetracyclines - FDE,
Photosensitivity
Quinolones
Ciprofloxacin : Rash,photosensitivity
ERYTHROMYCIN – Safest
Anticonvulsants
- Phenytoin
- Carbamazapine Epoxide
- Phenobarbitone hydroxylase
- Sodium Valproate
• Anticonvulsant hypersensitivity syndrome
• DRESS Syndrome
• SJS / TEN
• Exanthematic rash
• Pseudolymphoma
Anti-tuberculous drugs
- Thiacetazone
- Rifampicin
- INH
- Ethambutol
PYRAZINAMIDE- Safest
Imidazoles
Fixed drug eruptions
Cardiac drugs
• B-Blocker - Psoriasis,
Exfoliative dermatitis
• ACE-Inhibitor - Pemphigus,
Angioedema
• Vasodialators - Hypertrichosis
• Frusemide - Bullous eruption
• Thiazides - Photosensitivity
• Amiordarone - Pigmentation
Antimalarials : Chloroquine
- Rash,pigmentation
Antipsychotics : Chlorpromazine
- Pigmentation
NSAID - Aspirin, phenylbutazone,
FDE, Purpura
- Paracetamol (Safest)
Anticoagulants - Hair loss,
- cutaneous necrosis
Temporal correlation
Cross-sensitivity
Polysensitivity
Topical / Systemic use
DIAGNOSIS
Suspected eruptionNew Drug (6-8 weeks)
Pruritus Rash- Exanthematic- SJS/TEN- EM- Others
Stationary ProgressiveOR
Non-progressive
Observation
Drug Reaction
CONTINUE DRUG STOP DRUG(Pruritus, acneiform eruption Start alternative urticaria, photosensitivity) (other group)
Multiple Drugs
Stop: most likely drug Stop all drugs(one at a time) 2-3 weeks
Reintroduce (one at a time)
Exanthem / Exanthematic rash
HIV
Rechallenge
In-vivo / In-vitro testing
Role of steroids
Precautions
THANK YOU