2.medikamentozni Egzantemi

drug eruptions
are common.
may be fatal.
I will present
1. approach 2. FDE - EM - TEN
morphological diagnosis non-drug causes history lists elimination symptomatic therapy skin tests provocation prohibition
steps of approach
morphological non-drug history lists elimination symptomatic skin tests provocation prohibition
maculopapular is the most common rashform.
is the second most urticaria common form.
may continue for lichenoid months after eruption the stop of the drug.
this patient was acneiform lesions using acneiform cortisone occurred for post-traumatic eruption as a side effect. cerebral edema.
oral contraceptives erythema nodosum may be the cause.
iodide is used as iodide is present is an characterized intravenous iododerma in cough by radiocontrast vegetations. remedies. media.
cutaneous side effects of drugs any may simulate distribution almost every any course skin diseases.
any elemantary lesion
measles, rubella etc. are also maculopapular rashes.
urticaria
TBC, Behets disease etc. also cause erythema nodosum.
non-drug causes should be excluded for the URI, TB, Behets diagnosis of drug disease etc. also cause erythema eruption. nodosum.
be patient
ask some drugs name by name

evaluate time factors
morphological non-drug time factors history cerebral trauma should be lists phenytoin for the first time elimination evaluated rash symptomatic very skin -5 tests-4 -3 -2 -1 0 week carefully. provocation prohibition
morphological non-drug time factors history a drug, which has not been used cerebral trauma causes an be lists before, usually should phenytoin eruption after a sensitization elimination evaluated period of several weeks.rash symptomatic very skin -5 tests-4 -3 -2 -1 0 week carefully. provocation prohibition
morphological non-drug history pyelonephritis lists bactrim elimination symptomatic skin -5 tests-4 -3 provocation prohibition
time factors should be evaluated very -2 -1 0 carefully.

relapse
bactrim
rash
week
morphological non-drug time factors history pyelonephritis relapse a drug, which has been used be lists before, usually should causes an bactrim bactrim elimination evaluated eruption immediately . rash symptomatic very skin -5 tests-4 -3 -2 -1 0 week carefully. provocation prohibition
morphological non-drug history lists bactrim elimination symptomatic skin -5 tests-4 -3 provocation prohibition

aspirin
rash
day
morphological non-drug time factors history if the eruption is urticaria, only should be because lists aspirin is the culprit, bactrim aspirin urticaria occurs within a day after elimination evaluated urticaria drug intake. symptomatic very skin -5 tests-4 -3 -2 -1 0 day carefully. provocation prohibition
morphological non-drug time factors history if the eruption is maculopapular, the culprit, be lists both drugs are should bactrim aspirin because maculopapular rash may elimination evaluated maculodelay for several weeks. papular symptomatic very skin -5 tests-4 -3 -2 -1 0 day carefully. provocation prohibition
morphological non-drug history lists captopril elimination symptomatic skin -5 tests-4 -3 provocation prohibition

angioedema mo.
morphological non-drug time factors history a drug, which has been used should be safely for months even years, may lists captopril also cause a cutaneous side elimination evaluated angioeffect. edema symptomatic very skin -5 tests-4 -3 -2 -1 0 mo. carefully. provocation prohibition
morphological non-drug history lists previously ampicillin safe elimination symptomatic skin -5 tests-4 -3 provocation prohibition

uri ampicillin
rash
week
morphological non-drug time factors history ampicillin, which has been used uri should be safely before, may cause a rash in lists ampicillin safe the presence of infectious elimination evaluated rash mononucleosis. symptomatic very skin -5 tests-4 -3 -2 -1 0 week carefully. provocation prohibition
thousands of drugs
hunderds of rash types

no one remember all of them !
a guide, which contains previous hunderds of rash types experiences, no one should be used. remember
all of them !
thousands of drugs
textbook
prospectus
internet
treatment
=
cessation of drugs
all non-vital drugs should be = stopped ! cessation

of drugs
treatment
all if angioedema drugs should even if there is an occurs be stopped in a patient evident non-drug because who is of using risk of cause of urticaria, laryngeal vitamins, edema.
do not say to a patient that we have stopped all of your drugs. that is the whole treatment.
morphological drugs for non-drug history symptomatic relief lists should be prescribed elimination according to the symptomatic skin tests morphological provocation diagnosis. prohibition
do not give an order like that inject one ampule of cortisone.
precise diagnosis
=
rechallenge with drugs one by one
if there is risk for death, provocation should not be rechallenge with drugs done ! one by one
precise diagnosis
indirect diagnosis
prick-patch tests
prick test is prick test detects useful in type I allergy to a urticarial given substance. rashes.
patch patch test test is detects useful type in IV allergy maculopapular to a given substance. rashes.
fixed drug eruption, erythema multiforme and toxic epidermal necrolysis will be briefly discussed in the rest of the presentation.
fixed drug eruption
main elementary lesions are round erythematous macules.
fixed drug eruption
these erythematous macules leave hyperpigmentation.
fixed drug eruption
if the responsible drug is used again, the macules redden.
fixed drug eruption
blisters may develop on the active lesions.
fixed drug eruption
glans penis is commonly involved.
fixed drug eruption
an erosion occurs after rupture. it may look like a chancre.
fixed drug eruption

remnants of bullae indicates fixed eruption; induration, syphilis. palpation should be done with gloves !
an erosion occurs after rupture. it may look like a chancre.
erythema multiforme
in the minor form macules and papules,
erythema multiforme
in the major form bullae dominate.
erythema multiforme
especially acral regions and
erythema multiforme
periorificial regions are involved: mouth, eye, anogenital region.
erythema multiforme
erythematous rings with different hues
erythema multiforme
target lesion is pathognomonic.
erythema multiforme
target lesions are seen both in minor and major forms.
erythema multiforme
erythema multiforme may also be due to infections, especially herpes simplex. post-herpetic EM usually has a recurrent course.
erythema multiforme
Stevens-Johnson syndrome
bullae + mucosal lesions + fever
erythema multiforme
there are sores in the mouth and eyes.
toxic epidermal necrolysis
there are generalized bullae and widespread erosions.
it looks like staphylococcal scalded skin syndrome.
targetoid and mucosal lesions are usually enough for differentiation.
a biopsy should be done in doubtful cases.
it is treated like a burn.
unfortunately, the mortality rate is almost 50%.
maculopapular rash, which is the most common form of drug eruptions, may progress to toxic epidermal necrolysis, if the causative is not stopped.

2.medikamentozni Egzantemi

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2.medikamentozni Egzantemi

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drug eruptions

1. approach 2. FDE - EM - TEN

maculopapular is the most common rashform.

is the second most urticaria common form.

oral contraceptives erythema nodosum may be the cause.

any elemantary lesion

measles, rubella etc. are also maculopapular rashes.

TBC, Behets disease etc. also cause erythema nodosum.

ask some drugs name by name

time factors should be evaluated very -2 -1 0 carefully.

time factors should be evaluated very -2 -1 0 carefully.

time factors should be evaluated very -2 -1 0 carefully.

time factors should be evaluated very -2 -1 0 carefully.

hunderds of rash types

all non-vital drugs should be = stopped ! cessation

do not give an order like that inject one ampule of cortisone.

fixed drug eruption

main elementary lesions are round erythematous macules.

fixed drug eruption

these erythematous macules leave hyperpigmentation.

fixed drug eruption

if the responsible drug is used again, the macules redden.

fixed drug eruption

blisters may develop on the active lesions.

fixed drug eruption

glans penis is commonly involved.

fixed drug eruption

an erosion occurs after rupture. it may look like a chancre.

fixed drug eruption

in the minor form macules and papules,

in the major form bullae dominate.

especially acral regions and

periorificial regions are involved: mouth, eye, anogenital region.

erythematous rings with different hues

target lesion is pathognomonic.

target lesions are seen both in minor and major forms.

bullae + mucosal lesions + fever

there are sores in the mouth and eyes.

toxic epidermal necrolysis

toxic epidermal necrolysis

there are generalized bullae and widespread erosions.

toxic epidermal necrolysis

it looks like staphylococcal scalded skin syndrome.

toxic epidermal necrolysis

targetoid and mucosal lesions are usually enough for differentiation.

toxic epidermal necrolysis

a biopsy should be done in doubtful cases.

toxic epidermal necrolysis

it is treated like a burn.

toxic epidermal necrolysis

unfortunately, the mortality rate is almost 50%.

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