O, BRAUN - FALCO G, PLEWIG H. H. WOLFF Ais One 1en deb 8).4) DERMATOLOGY Second, Completely Revised Edition 6 Byala‘chutes viral are bacterial exanthesss, where corti. costeroids can be viewed as relatively cootraindl- cated, I corticosteroids are given, then an adequate dosage should be oploe at Teast 60 img, pred risone dai, perbape in tw divided desea, should be presribed.In addition, antihistamines areoften Iheipl for relieving pruritus, When a type I teac- tiem is suspected, if maiken pood sense to employ these agers, Topical. Good topical suring care can greatly dared ibe eoure «deg earn The choice ‘an appropriase ir tr using a cream of ointanent fe dry essen, dressings with a lotion for weeping oF ay ‘corticonternkds enay be helpful for pruritic initeated lesions, wach as lichesoid eruptions. As sntiprusitic agents they ate expensive and ine: tive end are not needed for a macular exanther. the main penbler is praites, poldacanol added to an appropriate vehicle may offer relict Severe Skin Reactions: Definition. Acute life-threateeing, usually drug: inuduced, disorders cbaracterited by widespread loss of epidermis which prove faa in about 20% the date Hor which we do sot provide other references reflect the experience af this group. The thrce diseases of most interest are Stevers-Iohnson syndrome (3)5). toxic epidermal ‘pecrolysis (TEN) with maculae, and the SIS-TEN overlap, They represent a disease spectrum and val be efreed bh aleteely an eve an rae tio, Eplderstology. The German Cenéer for Document- ng Severe Skin Reactions has been collecting epi demmiologic data since 1396.00 hoapitalized patients vith severe skin reactions, The incidence fs about wo per snillsn inhabitants The reactions are ‘ighily move commons in women (a ratio of 55:45). ‘Farther detadls are shown in Table 10.4. The age distributions. are also shewrn. forse males ere cme nats es than 40 years of age, while 755 of the patients with, ‘SJSITEN overlap and TEN are olde than 40 years. ‘The severe skin reactions ate associated with = mortality of about 18%, he Resse of acre kis reactions in pa seas nviAnis tone. Deis estimated us at least goo.fold higher than inthe geneeal popula: ‘toon, Patients with brain tumors or Bead injuries appear at greater risk, a8 do these with lupas cerythematozes and bone marrow transplast recip: js Germany, All ‘of paticens. Table 10,3 shows ibe classification of jets. severe eatancous reactions cmployediby the "Dok: snentationigentrun shwerer Hautreakriowen™ or “Center for Documenting Severe Skin Reactions", sstady group based at the Univesity of Freiburg ‘Table 10.5, Definitions af severe skin reactions Frlolngy ase Most severe skin reac: tions are caused by medicatioes. The agents in- -criminated are shawn i Table 10,5. The risk for “ie Feature Erythema metre maja Ermine bate esa than 10% of the bo ariace ‘Typocal target ievions on the pal sade ims haps tute anata na! Iai ee avcoua ute Seeemtsboheson spodroene rms ot bist Se hn 1% of by tc ‘ypeal urge! lrvica wd macula primary tt Hemrhaga-etonireestont on at hawt one msconlvrface Transition bereee Stevens okaon —frosonsce Bien imvcving 16-10% af ha bd ere ydrometonceptermal ecroyais Widespread atypical tne ein al cular Hemeribagscrtunive leo oat Wat coe masconal arte “hak plier al nce males ge bate rote then 30% of the dy sac lth macolae Wepre lone te pce (ually ecu sucon bexins aa opie reset rote than 10% of bey surice sith ditin Notre eens ti mecca eed efecto (Ceually ernie sean! Lexiswetem it ix relatively fat and then first noticed whee it becomes totic oF inflazned. If the epi- dermal changes are not proasinent hist ci See ene clanot spark the ewe posse Linear paoriasis, linear lichen: planus and linear Perokeratosis can be excluded with a biepay, ‘Therapy: None is needed, which is just as well since none is erailable, The rare lesions that inch can be treated with antipruricic agents such ax poldeca- fol creams o¢ topical eweticesteraids, Bibliography ‘rn (ops) The rd ace: Meshing discos. Cin DE vacad wr 3it=33y Dott Cle 6 Gc 5 ip Scere fil ning ede ransorsc armpits teary Flsalog in Garcia Spadconse saber Marney SR. ouces A pra Blockage of be xh ‘socied womh stilts! gaurs carcinesd by sen ‘bined Hi amd Ha receptor antagonists. Evidence for ax ingested Harps unas se gl | Met 300: Sack uh oeases MW” (py) Blood etivty anociated with noradeeratine prowlard fashintha car ‘nod apndcoese. Br | Dermatol 90:47 61 Familial Lane Fl ipo) amare hereditacis. Ach Dit nated Spy yah (ryan HG, Conky Rl (ops) Para ryt 6 acral se- (Arch ren 948) 46 ‘eeythers Anmalare Crieifaguen Beeler GS, Janes RE J (83) Erp annatuee cers: fegem | Az Acad Dermatol: Darker | (get) De Férytheme amnulaire centrifuge (try: ‘hart papelocircine etchroniqae} ede quel. pu Seeatepions ages mn Dermal S776, ‘are Eye praa repent kin mates tations ina pate with earcnarma Bf bean, Asch r= Kaveakacni 7, Saito & (ioaa} Erythema gyracem stead ory algae 1 urerock &, Ceben PR (998) ERAN gyramum repens TAMA srr Eton Ermine ss) Eye grec ogi ‘con Curie evvenahe Ach Dara i ip—éot Septet yest Perna see Frogs foes (ip) Fania anna ery Nace. Anogpateaty cow docdeint aaaticn, Bf ‘Dermanal 73:99 68 frindocas Sk Wokcessan WX: (187) Fam ‘aneulare Reporte wo cases sn tevew of the itera: ‘ee, | un Acad Derstitel tste0 ~ 20 Ite i i mapa ch Dis Child yor ca ony ui yee emt an Dat 04} ~ 1051 cen Hr is) Pitan rt ing ith as ke Tesi — ‘a historical ‘lin Exp Dermatol 15: ang=357 ech@ivams Erythema Scarlatiniforse Lauiecker 11 (eygah Th nitorme: dete ‘qeamatiracs recidivaca, rch Derinitol Sypbilel =e8: Sasa Landtbales M, Mt SM, Scheaby U et al ast) Erythema scartat desquammativum ceckdivans Vecalisaten Hastare® 9648-485,