Severe cutaneous adverse reactions

From greek.doctor
  • DRESS syndrome
    • Drug-related eosinophilia and systemic symptoms
      • Also called drug-induced hypersensitivity syndrome
    • Drugs
      • Allopurinol
      • Antiepileptics
      • Antibiotics
    • Risk factors
      • Older age
      • Renal failure
      • Certain HLA alleles
    • Clinical features
      • Fever
      • Pruritic morbilliform rash
      • Facial oedema
    • Multiorgan failure can occur
    • Fatal in 10%
    • Treatment
      • Drug cessation
      • Steroids
  • Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS)
    • If < 10% of skin surface is involved -> SJS
    • If 10 – 30% of skin surface is involved -> SJS/TEN overlap
    • If > 30% of skin surface is involved -> TEN
    • Drugs
      • Antibiotics
      • Antiepileptics
      • Sulpha drugs
      • Allopurinol
    • Risk factors
      • HIV infection
    • Clinical features
      • High fever
      • Painful erythematous macules
      • -> Lesions form bullae
      • -> Extensive, full-thickness epidermal necrosis and sloughing
      • Resembles superficial burns
      • Mucous membranes almost always involved
        • Stomatitis
        • Oral ulcers
        • Conjunctivitis
        • Urethritis
      • Circulatory shock
    • Diagnosis
      • Clinical
      • Positive Nikolsky sign
    • Treatment
      • Supportive care
      • Drug cessation
      • High-dose steroid
      • IV immunoglobulin
      • GM-CSF
    • Mortality 10 – 50%
  • Acute generalized exanthematous pustulosis (AGEP)
    • Drugs
      • Penicillins
      • Quinolones
      • Sulpha drugs
    • Clinical features
      • Erythematous, oedematous pustules
      • Begin in intertriginous areas, progress over the whole body
      • Fever
    • Treatment
      • Drug cessation
      • Antipyretics
      • Oral steroids