Drug eruption Classification and external resources
Examples of drug eruptions. (A) Bullous dermatitis caused by sulfathiazole (B) Fixed drug eruption caused by phenolphtalein (C) Bullous erythema multiforme (D) Diffuse photosensitivity reaction.
ICD-10 L27.0, L27.1 ICD-9 692.3, 782.1 eMedicine derm/104 MeSH D003875
In medicine, a drug eruption is an adverse drug reaction of the skin. Most drug-induced cutaneous reactions are mild and disappear when the offending drug is withdrawn. Drugs can also cause hair and nail changes, affect the mucous membranes, or cause itching without outward skin changes.
Drug eruptions are diagnosed mainly from the medical history and clinical examination. However, they can mimic a wide range of other conditions, thus delaying diagnosis (for example, in drug-induced lupus erythematosus, or the acne-like rash caused by erlotinib). A skin biopsy, blood tests or immunological tests can also be useful. If the causative agent can not be withdrawn, the symptoms should be relieved as much as possible.
It is estimated that 2—3 percent of hospitalised patients are affected by a drug eruption, and that serious drug eruptions occur in around 1 in 1000 patients.
The drug eruption can be an expected adverse effect or an unexpected effect (idiosyncratic).
Some of the most severe and life-threatening examples of drug eruptions are erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, hypersensitivity vasculitis, DRESS syndrome, erythroderma and exanthematous pustulosis.
The most common type of eruption is a morbilliform (resembling measles) or erythematous rash, but the appearance may also be urticarial, papulosquamous, pustular, purpuric, bullous (with blisters) or lichenoid. Angioedema can also be drug-induced (most notably, by angiotensin converting enzyme inhibitors).
The underlying mechanism can be immunological (such as in drug allergies) or non-immunological (for example, in photodermatitis or as a side effect of anticoagulants). A fixed drug eruption is the term for a drug eruption that occurs in the same skin area every time the person is exposed to the drug. Eruptions can occur frequently with a certain drug (for example, with phenytoin), or be very rare (for example, Sweet's syndrome following the administration of colony-stimulating factors).
The culprit can be both a prescription drug or an over-the-counter medication.
Examples of common drugs causing drug eruptions are antibiotics and other antimicrobial drugs, sulfa drugs, nonsteroidal anti-inflammatory drugs (NSAIDs), biopharmaceuticals, chemotherapy agents, anticonvulsants, and psychotropic drugs. Common examples include photodermatitis due to local NSAIDs (such as piroxicam) or due to antibiotics (such as minocycline), and the rash following ampicillin in cases of mononucleosis.
- ^ Manders SM (June 1995). "Serious and life-threatening drug eruptions". Am Fam Physician 51 (8): 1865–72. PMID 7762478.
- ^ a b Valeyrie-Allanore L, Sassolas B, Roujeau JC (2007). "Drug-induced skin, nail and hair disorders". Drug Saf 30 (11): 1011–30. doi:10.2165/00002018-200730110-00003. PMID 17973540.
- ^ Roujeau JC, Stern RS (November 1994). "Severe adverse cutaneous reactions to drugs". N. Engl. J. Med. 331 (19): 1272–85. doi:10.1056/NEJM199411103311906. PMID 7794310. http://content.nejm.org/cgi/pmidlookup?view=short&pmid=7794310&promo=ONFLNS19.
- ^ Scheinfeld N (August 2003). "Phenytoin in cutaneous medicine: its uses, mechanisms and side effects". Dermatol. Online J. 9 (3): 6. PMID 12952753. http://dermatology.cdlib.org/93/reviews/dilantin/scheinfeld.html.
- ^ Cohen PR (2007). "Sweet's syndrome--a comprehensive review of an acute febrile neutrophilic dermatosis". Orphanet J Rare Dis 2: 34. doi:10.1186/1750-1172-2-34. PMC 1963326. PMID 17655751. http://www.ojrd.com/content/2//34.
Diseases of the skin and appendages by morphology GrowthsPigmentedDermal and
PurpuraMacularthrombocytopenic purpura · actinic purpuraPapularIndurated
Dermatitis and eczema (L20–L30, 690–693,698) Atopic dermatitisBesnier's prurigo Seborrheic dermatitisPityriasis simplex capillitii · Cradle cap Contact dermatitis
EczemaAutoimmune estrogen dermatitis · Autoimmune progesterone dermatitisBreast eczema · Ear eczema · Eyelid dermatitis · Hand eczema (Chronic vesiculobullous hand eczema, Hyperkeratotic hand dermatitis) Pruritus/Itch/
Prurigoby location: Pruritus ani · Pruritus scroti · Pruritus vulvae · Scalp pruritusDrug-induced pruritus (Hydroxyethyl starch-induced pruritus) · Senile pruritus · Aquagenic pruritus (Aquadynia)Adult blaschkitis · due to liver disease (Biliary pruritus · Cholestatic pruritus) · Prion pruritus · Prurigo pigmentosa · Prurigo simplex · Puncta pruritica · Uremic pruritus
Other/ungrouped Urticaria and erythema (L50–L54, 695, 708) Urticaria
(acute/chronic)Allergic urticariaUrticarial allergic eruptionPhysical urticariaOther urticariaEpisodic angioedema with eosinophilia · Hereditary angioedema
drug eruptionFigurate erythemaOther erythema
Symptoms and signs: skin and subcutaneous tissue (R20–R23, 782) Disturbances of skin sensation/
Circulation Edema Other Immune disorders: hypersensitivity and autoimmune diseases (279.5–6) Type I/allergy/atopy
(T-cells)ForeignAllergic contact dermatitis · Mantoux testAutoimmune
Drug reactions (Y40-Y59, E930-E949) Adverse drug reaction/
antibiotics: Penicillin drug reaction · Sulfonamide hypersensitivity syndrome · Urticarial erythema multiforme · Adverse effects of fluoroquinolones
hormones: Steroid acne · Steroid folliculitis
blood: Anticoagulant-induced skin necrosis · Warfarin necrosis · Vitamin K reaction · Texier's disease
anticonvulsant: Anticonvulsant hypersensitivity syndrome
water-balance/acid-base: Allopurinol hypersensitivity syndrome
pulmonary: Leukotriene receptor antagonist-associated Churg–Strauss syndrome· Bullous drug reaction · Drug-induced acne · Drug-induced angioedema · Drug-related gingival hyperplasia · Drug-induced lichenoid reaction · Drug-induced lupus erythematosus · Drug-induced nail changes · Drug-induced pigmentation · Drug-induced pseudolymphoma · Drug-induced urticaria · Fixed drug reaction · Stevens–Johnson syndrome · Injection site reaction · Linear IgA bullous dermatosis · Toxic epidermal necrolysis · HIV disease-related drug reaction · Photosensitive drug reaction · Serum sickness-like reaction
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