DR. BIJAY KR.

YADAV
Holly vision technical campus
Shankhamul, Kathmandu
Drug eruption
 Drug eruption or Drug reaction : are the unwanted, harmful & adverse
effects of the drugs in the body organs. Skin disorder are the frequent
form of drug side effect.
 Types of drug eruption :
1. Severe life threating eruption
a. Angioedema / Anaphylactic shock ( IgE mediated reaction)
b. Erythema multiformes & Stevens Johnson’s syndrome
 ( tocix Epidermal Necrolysis)
2. Exanthematic eruption
 Common type
 Red / pink macules develop over
the trunk & limbs

a. A lichenoid rash ( similar to lichen

planus ) :- Carbamazipine
b. Vascular eruption :
- Develop over the legs & less
frequently over arms & trunk

- Thiazide, Diuretics
a. Urticarial rash : produced by
Penicillin, Aspirin
3. Photosensitivity Rashes :
By solar ultraviolet spectrum - Red,
papules or plaque like rash
By drugs – like Tetracycline &
sulphonamides
4. Blistering rash :
- Furosemide, captopril, penicillamine,
Naproxen
5. Fixed drug eruption :
- Dapsone, Sulphonamide, Tetracycline
& Mefenamic acid
- The areas becomes inflammed & may
form blisters
6. Lupus erythematous
7. Hair & nail changes
 Urticaria
 Also known as Hives, Nettle-rash
 Rapid appearance of wheals which may be accompanied by
angioedema
A wheal consists of 4 typical features:
1. swelling of variable size, surrounded by a reflex erythema
2. Pruritic (itch!)
3. Blanche with pressure
4. Fleeting (“Leaves no trace”)
-No scarring
 Angioedema
 Sudden, pronounced swelling of the lower dermis and subcutis
 Sometimes painful rather than itching
 Frequent involvement of mucous membranes
 Resolution is slower than for wheals and can take up to 72 hours
1. Non-pitting edema
2. SkiNon-dependent areas

It is not: “pre-tibial pitting edema”

Urticaria / Angioedema
Classification
 Acute
 < 6 weeks duration
 Chronic
 > 6 weeks duration
 Idiopathic – as much as 70%
 Autoimmune
 Urticarial vasculitis
The main types of Urticaria :
1. Physical
 Cold
 Soalr
 Heat
 Cholinergic
 Dermographism (Immediate pressure urticaria)
 Delayed pressure
2. Hypersensitivity
3. Autoimmune
4. Pharmacological
5. contact
Causes :
1. Endogenous cause :
 Infection
- Bacterial
- Viral ( Hepatitis, HIV infection during seroconversion etc )
- Mycoplasma
- Intestinal parasites
 Connective tissue disorder
 Hypereosinophilic syndrome
 Hyperthyroidism
 Cancer
 lymphomas
2. Exogenous cause :
 Drugs both systemic & topical
 Foods & food additives
 Bites
 Pollens
 Insects venoms
 Inhalants
 Animal dander
Clinical features :
 Sudden appearance of pink itchy wheals
 Anywhere in the skin and each last for less than a day
 Lesions may enlarge rapidly and some resolve centrally &
take annular shape
 In acute anaphylactic reaction – wheals cover most of skin
surface
 In chronic urticaria – only few wheals develop every day
Complications
1. Anaphylactic reactions with laryngeal edema and
asphyxiation ; edema of tracheobronchial tree leading to
Asthma.
2. Interference with sleep due to itching
3. Sedation due to antihistamines.
Diagnosis
1. Is it urticaria ?? :
- evanescant &erythematous wheals
- lesions subside within 72 hrs leaving behind
normal skin
2. Which type of urticaria ?? -
History : hlo drug intake, any physical stimuli which
aggravate the urticaria, history suggestive of any
infection - Systemic review: to rule out an underlying
disease - Investigations : Routine screening
tests, diet elimination test, provocation of urticaria,
Autologous serum skin test (AAST)- done in
autoimune urticaria
Treatment :
THANK YOU