Drugs of special interest in cutaneous drug eruption
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This document lists various drugs that can cause cutaneous adverse drug reactions and provides brief descriptions of their use, common reactions, and in some cases percentage of risk. The drugs discussed include allopurinol, abacavir, penicillin, NSAIDs, radiocontrast media, anti-convulsants, vancomycin, sulphonamides, cancer chemotherapy drugs, glucocorticoids, biologic therapies, antimalarial agents, and others. For each drug, 1-3 sentences summarize their use, common skin reactions observed, and any notable risks.
Drugs of special interest in cutaneous drug eruption
- 1. • Allupurinol • Anti-HIV medication • Penicillin • NSAIDs • Radiocontrast media • Anti-convulsant • Sulphonamide • Vancomycin • Cancer chemotherapy • Glucocorticoids • Biologic therapies DRUGS OF SPECIAL INTEREST
- 2. › Uric acid reducing drug › Tx of gout and renal calculi › Effect : – Mild maculopapular eruption – Hypersensitivity reaction/DRESS (drug reaction with eosinophilia and systemic symptoms) – Stevens-Johnson syndrome (SJS) / toxic epidermal necrolysis (TEN) Allupurinol (<1%)
- 3. › Abacavir › 4-8% risk of hypersensitivity › Effect : – Type 1 (dyspnea, diarrhea, hypotension, shock on rechallenge) – Delayed hypersensitivity (rash, late onset of hepatitis) – Lower risk in African (HLAB*5701) › Nevirapine › High risk › Effect: – Maculopapular eruption – SJS/TEN – Increase dosage gradually Anti HIV drug (>10%)
- 4. › Β-lactam antibiotic (bactericidal) › For gram +ve organism › Effect – Cutaneous : Morbilliform, urticarial, angioderma (Due to IgE deposition) – Delayed reaction : Maculopapular reaction Penicillin (1%)
- 6. › Aspirin (Salicyclates) – COX inhibitor › Effect : – Urticaria/angioderma (24 hours) – Rhinosinisitis-asthma syndrome (an hour) – Phototixicity – Pseudoporphyria (Naproxen) – DRESS (COX-2 inhibitor, oxicam derivatives) – SJS/TEN (oxicam derivatives, phenylbutazone) NSAID (1%)
- 7. › Used to improve the visibility of internal bodily structures in X- ray-based imaging techniques such as computed tomography (CT), radiography, and fluoroscopy. › Mostly : Iodine and Barium › High-osmolality (ionic) › Effect : – Uriticaria Radiocontrast Media
- 8. › Phenobarbitol, carmabazepine, phenytoin, lamotrigine › Common in Chinese Han (HLA association) › Effect : SJS, TEN › Safest : Lamotrigine Anticonvulsant
- 9. › Bactericidal antibiotic (gram +ve organism) › Effect : – Linear IgA bullous dermatosis – Red man syndrome (on rapid IV) – Histamine related anaphylactoid reaction (flushing, diffuse maculopapular eruption, hypotension, cardiac arrest) Vancomycin
- 10. › Antibacterial › sulphamethoxazole +trimethoprim (eruption at higher rate) › Effect : – Cutaneous eruption – SJS – TEN Sulphonamide
- 11. › Side effect : Alopecia, stomatitis, nail abnormalities, sterile cellulitis › Acral erythema (doxorubicin, methotrexate, hydroxyurea, 5- fluorouracil) – (Tx : pyridoxine) › Ig E mediated, ARDS, hypotension (Cisplastin) –(Tx: H-blocker) › Follicular eruption, nail toxixity (Cetuximab) –(Tx : antibiotic) Cancer Chemotherapy
- 12. › Cushing’s : Acneiform eruption, atrophy, striea › High doses : Slow wound healing › Allergy : Contact dermatitis Glucocorticoids
- 13. › Cytokines, cytokines antagonist, monoclonal antibodies › Injection site : redness and necrosis › Monoclonal ab : urticaria, angioderma, anaphylactic reaction, serum sickness. › INF- : alopecia, pruritic dermatitis › Granulocyte colony-stimulating factor : neutrophilic dermatoses, sweet’s syndrome, pyoderma gangrenosum, psoriasis. Biological Therapy
- 14. › Acute febrile neutrophilic dermatosis Sweet’s syndrome
- 15. › Used for tx of several skin dz, but also can induce one › Black pigmentation of face, mucous membrane, pretibial and sublingual › Effect : › Pruritus (Chloroquine) › Generalized yellow discolouration (quinacrine) › Pustules (AGEP) › DRESS Antimalarial agent