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