Overview
How are drug eruptions characterized?
What should be the initial focus of history in suspected drug eruptions?
What should be included in the medication history of suspected drug eruptions?
Which clinical features should be the focus of the physical exam for drug eruptions?
Which morphologies and physical features are characteristic of drug eruptions>?
What is the role of lab testing in the diagnosis of drug eruptions?
What are the principles for medical management of drug eruptions?
Which conditions may complicate the recovery of drug eruptions?
What are the common morphologies of drug eruptions?
Which medications may cause drug eruptions?
How does withdrawal of medication affect a drug eruption?
What are the two types of reactions in drug eruptions?
What are the types of immunologically mediated drug eruptions?
What is the role of th17 T cells in the pathophysiology of drug eruptions?
Which agents are associated with specific types of drug eruptions?
What is the role of antibodies in the pathogenesis of type IV drug eruptions?
Which features are used to classify nonimmunologically mediated drug eruptions?
What is the significance of argyria in drug eruptions?
What are adverse effects in nonimmunologically mediated drug eruptions?
What is the role of direct release mast cell mediators in the pathophysiology of drug eruptions?
What is an example of idiosyncratic reactions in nonimmunologically mediated drug eruptions?
What is the role of imbalance of endogenous flora in the pathophysiology of drug eruptions?
What is the role of intolerance in the pathophysiology of drug eruptions?
What is the Jarisch-Herxheimer phenomenon in the pathophysiology of drug eruptions?
What is the role of overdosage in the pathophysiology of drug eruptions?
What is the role of phototoxic dermatitis in the pathophysiology of drug eruptions?
What are possible etiologies of fibrosing drug eruptions?
What are the rates of drug eruptions for commonly used medications?
What are the rates of drug eruptions in patients with HIV infection?
Which medications commonly cause serious drug eruptions?
Which medications are unlikely to cause drug eruptions?
Which medications are associated with specific morphologic patterns in drug eruptions?
Which psychotropic agents are associated with specific morphologic patterns in drug eruptions?
Which chemotherapeutic agents are associated with specific morphologic patterns in drug eruptions?
What are the cutaneous reactions of targeted chemotherapy agents?
What are the cutaneous reactions to cytokine therapy agents?
What is the prevalence of drug eruptions in the US?
What is the global prevalence of drug eruptions?
How does the prevalence of drug eruptions vary among males and females?
Which age group is at highest risk for drug eruptions?
What is the prognosis of drug eruptions?
What is the incidence of life-threatening drug eruptions?
What is the prognosis of exanthematous drug eruptions?
What is a possible complication of drug eruptions with hypersensitivity syndrome?
What is the prognosis of drug eruptions in patients with TEN?
What is included in patient education following a drug eruption?
What is included in patient education to prevent drug eruptions?
Presentation
What should be the focus of patient history in drug eruptions?
What should be included in the medication history of suspected drug eruptions?
What are the signs and symptoms of potentially severe or life-threatening drug eruptions?
What are morphological features that can help determine the causative medication for drug eruptions?
DDX
What are the differential diagnoses for Drug Eruptions?
Workup
What is the role of lab studies in the workup of drug eruptions?
What is the role of biopsies in the workup of drug eruptions?
What is the role of CBC count in the workup of drug eruptions?
What is the role of serum chemistry studies in the workup of drug eruptions?
What is the role of antibody and immunoserology tests in the workup of drug eruptions?
What is the role of direct cultures in the workup of drug eruptions?
What is the role of imaging studies in the workup of drug eruptions?
What is the role of skin testing in the workup of drug eruptions?
Which histologic findings suggest drug eruption?
Which histologic findings help differentiate Sweet syndrome from drug eruptions?
Which histologic findings indicate TEN in drug eruptions?
Treatment
What is the goal of medical care for drug eruptions?
How is drug eruption managed in patients who must continue taking the causative medication?
What are the treatment options for drug eruption?
What is included in medical care of severe drug eruptions?
Medications
Which medications are used in the treatment of drug eruptions?
Which medications in the drug class Corticosteroids are used in the treatment of Drug Eruptions?
Which medications in the drug class Immunoglobulins are used in the treatment of Drug Eruptions?
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Morbilliform drug eruption.
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Warfarin (Coumadin) necrosis involving the leg.
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Toxic epidermal necrolysis.
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Stevens-Johnson syndrome.
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Erythroderma.
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Erythema multiforme.
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Fixed drug eruption.
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Fixed drug eruption involving the penis.
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Oral ulcerations in a patient receiving cytotoxic therapy.
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Phototoxic reaction after use of a tanning booth. Note sharp cutoff where clothing blocked exposure.
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Vasculitic reaction on the legs.
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Lichen planus on the neck.
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Steroid acne. Note pustules and absence of comedones.
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Drug reaction to hydroxychloroquine (Plaquenil).
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Urticaria.
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Erythema nodosum.
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Confluent necrosis of the epidermis in toxic epidermal necrolysis.
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Perivascular mixed inflammatory infiltrate with eosinophils characteristic of drug-induced urticaria.
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Biopsy of pseudoporphyria shows a subepidermal blister with little to no inflammation.
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Confluent necrosis of the epidermis in toxic epidermal necrolysis.
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Superficial perivascular inflammatory infiltrate with numerous eosinophils characteristic of an exanthematous drug eruption.
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Target lesions of erythema multiforme.
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Papules and annular plaques.
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Superficial and mid-dermal perivascular infiltrate of lymphocytes and eosinophils. Foci of extravasation of erythrocytes.
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Numerous milia in a patient treated with vemurafenib.
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Dilated infundibular cyst.
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Paronychia.
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Male-pattern diffuse hair loss.
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Pink/fleshy perifollicular papules with diffuse alopecia.
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Horizontal section shows perifollicular fibrosis consistent with scarring alopecia.