Drug rash: Difference between revisions
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=== Table of Severe Drug Reactions === | === Table of Severe Drug Reactions === | ||
{| {{table}} | {| {{table}} | ||
| align="center" style="background:#f0f0f0;"|'''Charateristic''' | | align="center" style="background:#f0f0f0;"|'''Charateristic''' | ||
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| Mortality (%)||10||5-35||5||5-15 | | Mortality (%)||10||5-35||5||5-15 | ||
|} | |} | ||
;AGEP Acute generalized exanthematous pustulosis | |||
;DRESS drug reaction with eosinophilia and systemic symptoms | |||
;SJS Stevens-Johnson syndrome | |||
;TEN toxic epidermal necrolysis | |||
==Evaluation== | ==Evaluation== |
Revision as of 19:06, 17 December 2019
Background
ABCs of Drug Rashes
- Acute generalized exanthematous pustulosis (AGEP)
- Bullous disease, drug induced
- Captopril (ACE-inhibitor) induced angioedema
- Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome
- SJS/TEN
Clinical Features
- Sudden, usually morbilliform, often starts on face & trunk & spreads
- More polymorphous than viral exanthem
Differential Diagnosis
Erythematous rash
- Positive Nikolsky’s sign
- Febrile
- Staphylococcal scalded skin syndrome (children)
- Toxic epidermal necrolysis/SJS (adults)
- Afebrile
- Febrile
- Negative Nikolsky’s sign
- Febrile
- Afebrile
Table of Severe Drug Reactions
Charateristic | DRESS | SJS/TEN | AGEP | Erythroderma |
Onset of eruption | 2-6 weeks | 1-3 weeks | 48 hours | 1-3 weeks |
Duration of eruption (weeks) | Several | 1-3 | <1 | Several |
Fever | +++ | +++ | +++ | +++ |
Mucocutaneous features | Facial edema, morbilliform eruption, pustules, exfoliative dermattiis, tense bullae, possible target lesions | Bullae, atypical target lesions, mucocutaneous erosions | Facial edema, pustules, tense bullae, possible target lesions, possibl emucosal involvement | Erythematous plaques and edema affecting >90% of total skin surface with or without diffuse exfoliation |
Histological pattern of skin | Perivascular lymphocytcic infiltrate | Epidermal necrosis | Subcorneal pustules | Nonspecific, unless reflecting Sezary syndrome or other lymphoma |
Lymph node enlargement | +++ | - | + | + |
Lymph node histology | Lymphoid hyperplasia | - | - | No, unless reflecting Sezary syndrome or other malignancy |
Hepatitis | +++ | ++ | ++ | - |
Other organ involvement | Interstitial nephritis, pneumonitis, myocarditis, and thydoiditis | Tubular nephritis and tracheobronical necrosis | Possible | Possible |
Neutrophils | Elevated | Decreased | Very elevated | Elevated |
Eosinophils | Very elevated | No change | Elevated | Elevated |
Atypical lymphocytes | + | - | - | + |
Mortality (%) | 10 | 5-35 | 5 | 5-15 |
- AGEP Acute generalized exanthematous pustulosis
- DRESS drug reaction with eosinophilia and systemic symptoms
- SJS Stevens-Johnson syndrome
- TEN toxic epidermal necrolysis
Evaluation
- Typically a clinical diagnosis
Management
- Discontinue offending agent
- Supportive
- Topical steroids may help relieve pruritus
Disposition
- If no signs of anaphylaxis or significant sloughing, consider outpatient management