Research Article Elevated OPN, IP-10, and Neutrophilia in ...
Drug eruption - Mahidol · 2019-04-05 · • 1.numerous,small,non-follicular pustule 1.arising on...
Transcript of Drug eruption - Mahidol · 2019-04-05 · • 1.numerous,small,non-follicular pustule 1.arising on...
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Drug eruption
March 25,2015
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Outline
• Clinical features • Pathogenesis • How to approach? • Management?
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Need to know • Urticaria • Exanthematous rash • DRESS • Stevens-Johnson syndrome/TEN • Fix drug eruptions • Acute generalized exanthematous pustulosis • Photoallergic/Phototoxic. • Chemotherapy induced..
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Generalized erythematous and slightly edematous maculopapular rashes
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Erythema and edema of face and periorbital area
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Investigations
28/8/47 30/8/47 2/9//47
Total Eosinophil
1110 1690 2024
SGOT 42 98 69
SGPT 130 108 88
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Your Dx is
D R E S S ?
Drug Rash with Eosinophilia and Systemic Symptoms
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DRESS
• Aromatic antiepileptic agents (phenytoin, carbamazepine, phenobarbital)
• Sulfonamides, allopurinol, gold salts, dapsone, and minocycline.
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5 days after prednisolone 30mg/d
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5 days after prednisolone 30mg/d
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Gout after 2 weeks of
allopurinol
Toxic Epidermal Necrolysis from allopurinol
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Approach to the Acute Generalized Blistering Patient
History : Onset ,underlying disease, New Drug ,other symptoms? ( fever,sore throat )
Physical examination : target lesion nikolsky sign, epidermal necrolysis, mucosal involvement
Investigation : baseline lab,skin biopsy + Direct Immonofluorescence
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Differential diagnosis of TEN
• SSSS (Staphylococcal scalded skin syndrome )
• Autoimmune blistering disease (
pemphigus,linear IgA dermatosis.. ) • Erythema multiforme
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Generalized exanthem Cutaneous tenderness
Blistering ,denudation Nikolsky sign +
Generalized desquamation
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desmoglein-1 Apoptosis
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TEN SSSS
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Pemphigus vulgaris
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Bullous pemphigoid
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Erythema multiforme
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Take home pictures
• SJS/TEN : atypical target,
drug >>other
• Erythema multiforme : typical target
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8/2 13/2
• Cephalexin • Metronidazole • Celecoxib
RASH เคยได้ ampicillin 1-5 Dec 2006 cefoxitin 8-11 Jan 2007
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• Dx Acute generalized exanthematous pustulosis due to?
• • Rx D/C Cephalexin, Metronidazole,
Celecoxib 0.1% Triamcinolone lotion bid
Hydroxizine(10) 1*3 pc Prednisolone 30 mg/d
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The Journal of dermatology.vol 30:732-726,2003
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AGEP validation score of EuroSCAR study group
• </=0 ; no AGEP • 1-4 ; possible • 5-7 ; probable • 8-12 ; definite • exclude,only localized pustule,pustular last
longer than 3 wks or clear alternative diagnosis has been made by a dermatologist
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Diagnosis criteria
• 1.numerous,small,non-follicular pustule 1.arising on edematous base
• 2.fever above 38 c • 3.neutrophilia (>7000) with or without
mild eosinophilia • 4.subcorneal or intraepithelial or
subcorneal pustules on skin biopsy • 4.spontaneous resolution in less than 15
days Roujeau
JC et al,AGEP:analysis of 63 cases Arch Dermatol1991;127:1333-8
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4 days after discontinuation of drug And prednisolone 30mg/d
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Urticaria
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Fix drug eruptions
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Phototoxic reaction
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Diagnosis
4 Questions 1.Drugs>>reaction 2.Reaction >>Drugs 3.Dechallenge 4.Rechallenge
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Management
• Depend on type and severity of reaction • Consider the need of that drugs • Allergy CARD for patient !! • Genetics?
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The Other (should know)
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1. What is the clinical diagnosis?
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2. What is the clinical diagnosis?
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3. Name drug that causing this condition
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4. What is the diagnosis
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5. Name three cause of this presentation.