• Allupurinol

• Anti-HIV medication

• Penicillin

• NSAIDs

• Radiocontrast media

• Anti-convulsant

• Sulphonamide

• Vancomycin

• Cancer chemotherapy

• Glucocorticoids

• Biologic therapies

DRUGS OF SPECIAL INTEREST

› 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%)

› 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%)

› Β-lactam antibiotic (bactericidal)› For gram +ve organism› Effect– Cutaneous : Morbilliform, urticarial, angioderma (Due to IgE

deposition)– Delayed reaction : Maculopapular reaction

Penicillin (1%)

› 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%)

› 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

› Phenobarbitol, carmabazepine, phenytoin, lamotrigine› Common in Chinese Han (HLA association)› Effect : SJS, TEN› Safest : Lamotrigine

Anticonvulsant

› 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

› Antibacterial› sulphamethoxazole +trimethoprim (eruption at higher rate)› Effect :– Cutaneous eruption– SJS– TEN

Sulphonamide

› 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

› Cushing’s : Acneiform eruption, atrophy, striea› High doses : Slow wound healing› Allergy : Contact dermatitis

Glucocorticoids

› 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

› Acute febrile neutrophilic dermatosis

Sweet’s syndrome

› 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

Prepared by NZareef~

THANKS