| Drug eruption |
| Classification and external resources |
Examples of drug eruptions. (A) Bullous dermatitis caused by sulfathiazole (B) Fixed drug eruption caused by phenolphtalein (C) Bullous erythema multiforme (D) Diffuse photosensitivity reaction.
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| ICD-10 |
L27.0, L27.1 |
| ICD-9 |
692.3, 782.1 |
| eMedicine |
derm/104 |
| MeSH |
D003875 |
In medicine, a drug eruption is an adverse drug reaction of the skin. Most drug-induced cutaneous reactions are mild and disappear when the offending drug is withdrawn.[1] Drugs can also cause hair and nail changes, affect the mucous membranes, or cause itching without outward skin changes.[2]
Contents
- 1 Diagnosis
- 2 Classification
- 2.1 By appearance
- 2.2 By mechanism
- 2.3 By drug
- 3 References
Diagnosis[edit]
Drug eruptions are diagnosed mainly from the medical history and clinical examination. However, they can mimic a wide range of other conditions, thus delaying diagnosis (for example, in drug-induced lupus erythematosus, or the acne-like rash caused by erlotinib). A skin biopsy, blood tests or immunological tests can also be useful. If the causative agent can not be withdrawn, the symptoms should be relieved as much as possible.
It is estimated that 2—3 percent of hospitalised patients are affected by a drug eruption, and that serious drug eruptions occur in around 1 in 1000 patients.[3]
Classification[edit]
The drug eruption can be an expected adverse effect or an unexpected effect (idiosyncratic).
Some of the most severe and life-threatening examples of drug eruptions are erythema multiforme, Stevens–Johnson syndrome, toxic epidermal necrolysis, hypersensitivity vasculitis, DRESS syndrome, erythroderma and exanthematous pustulosis.
By appearance[edit]
The most common type of eruption is a morbilliform (resembling measles) or erythematous rash, but the appearance may also be urticarial, papulosquamous, pustular, purpuric, bullous (with blisters) or lichenoid.[2] Angioedema can also be drug-induced (most notably, by angiotensin converting enzyme inhibitors).
By mechanism[edit]
The underlying mechanism can be immunological (such as in drug allergies) or non-immunological (for example, in photodermatitis or as a side effect of anticoagulants). A fixed drug eruption is the term for a drug eruption that occurs in the same skin area every time the person is exposed to the drug. Eruptions can occur frequently with a certain drug (for example, with phenytoin[4]), or be very rare (for example, Sweet's syndrome following the administration of colony-stimulating factors[5]).
By drug[edit]
The culprit can be both a prescription drug or an over-the-counter medication.
Examples of common drugs causing drug eruptions are antibiotics and other antimicrobial drugs, sulfa drugs, nonsteroidal anti-inflammatory drugs (NSAIDs), biopharmaceuticals, chemotherapy agents, anticonvulsants, and psychotropic drugs. Common examples include photodermatitis due to local NSAIDs (such as piroxicam) or due to antibiotics (such as minocycline), and the rash following ampicillin in cases of mononucleosis.
References[edit]
- ^ Manders SM (June 1995). "Serious and life-threatening drug eruptions". Am Fam Physician 51 (8): 1865–72. PMID 7762478.
- ^ a b Valeyrie-Allanore L, Sassolas B, Roujeau JC (2007). "Drug-induced skin, nail and hair disorders". Drug Saf 30 (11): 1011–30. doi:10.2165/00002018-200730110-00003. PMID 17973540.
- ^ Roujeau JC, Stern RS (November 1994). "Severe adverse cutaneous reactions to drugs". N. Engl. J. Med. 331 (19): 1272–85. doi:10.1056/NEJM199411103311906. PMID 7794310.
- ^ Scheinfeld N (August 2003). "Phenytoin in cutaneous medicine: its uses, mechanisms and side effects". Dermatol. Online J. 9 (3): 6. PMID 12952753.
- ^ Cohen PR (2007). "Sweet's syndrome--a comprehensive review of an acute febrile neutrophilic dermatosis". Orphanet J Rare Dis 2: 34. doi:10.1186/1750-1172-2-34. PMC 1963326. PMID 17655751.
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Dermatitis and eczema (L20–L30, 690–693,698)
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| Atopic dermatitis |
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| Seborrheic dermatitis |
- Pityriasis simplex capillitii
- Cradle cap
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Contact dermatitis
(allergic, irritant) |
- plants: Urushiol-induced contact dermatitis
- African blackwood dermatitis
- Tulip fingers
- other: Abietic acid dermatitis
- Diaper rash
- Airbag dermatitis
- Baboon syndrome
- Contact stomatitis
- Protein contact dermatitis
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| Eczema |
- Autoimmune estrogen dermatitis
- Autoimmune progesterone dermatitis
- Breast eczema
- Ear eczema
- Eyelid dermatitis
- Hand eczema
- Chronic vesiculobullous hand eczema
- Hyperkeratotic hand dermatitis
- Autosensitization dermatitis/Id reaction
- Candidid
- Dermatophytid
- Molluscum dermatitis
- Circumostomy eczema
- Dyshidrosis
- Juvenile plantar dermatosis
- Nummular eczema
- Nutritional deficiency eczema
- Sulzberger–Garbe syndrome
- Xerotic eczema
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Pruritus/Itch/
Prurigo |
- Lichen simplex chronicus/Prurigo nodularis
- by location: Pruritus ani
- Pruritus scroti
- Pruritus vulvae
- Scalp pruritus
- Drug-induced pruritus
- Hydroxyethyl starch-induced pruritus
- Senile pruritus
- Aquagenic pruritus
- Adult blaschkitis
- due to liver disease
- Biliary pruritus
- Cholestatic pruritus
- Prion pruritus
- Prurigo pigmentosa
- Prurigo simplex
- Puncta pruritica
- Uremic pruritus
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| Other/ungrouped |
- substances taken internally: Bromoderma
- Fixed drug reaction
- Nummular dermatitis
- Pityriasis alba
- Papuloerythroderma of Ofuji
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noco (i/b/d/q/u/r/p/m/k/v/f)/cong/tumr (n/e/d), sysi/epon
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proc, drug (D2/3/4/5/8/11)
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Urticaria and erythema (L50–L54, 695, 708)
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Urticaria
(acute/chronic) |
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Allergic urticaria
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- Urticarial allergic eruption
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Physical urticaria
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- Cold urticaria
- Primary cold contact urticaria
- Secondary cold contact urticaria
- Reflex cold urticaria
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- Heat urticaria
- Localized heat contact urticaria
- Solar urticaria
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- Dermatographic urticaria
- Vibratory angioedema
- Pressure urticaria
- Cholinergic urticaria
- Aquagenic urticaria
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Other urticaria
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- Acquired C1 esterase inhibitor deficiency
- Adrenergic urticaria
- Exercise urticaria
- Galvanic urticaria
- Schnitzler syndrome
- Urticaria-like follicular mucinosis
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Angioedema
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- Episodic angioedema with eosinophilia
- Hereditary angioedema
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| Erythema |
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Erythema multiforme/
drug eruption
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- Erythema multiforme minor
- Erythema multiforme major (Stevens–Johnson syndrome, Toxic epidermal necrolysis)
- panniculitis (Erythema nodosum)
- Acute generalized exanthematous pustulosis
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Figurate erythema
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- Erythema annulare centrifugum
- Erythema marginatum
- Erythema migrans
- Erythema gyratum repens
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Other erythema
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- Necrolytic migratory erythema
- Erythema toxicum
- Erythroderma
- Palmar erythema
- Generalized erythema
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noco (i/b/d/q/u/r/p/m/k/v/f)/cong/tumr (n/e/d), sysi/epon
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proc, drug (D2/3/4/5/8/11)
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Symptoms and signs: skin and subcutaneous tissue (R20–R23, 782)
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Disturbances of skin sensation/
somatosensory disorder |
- Hypoesthesia
- Paresthesia (Formication)
- Hyperesthesia
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| Circulation |
- Cyanosis
- Pallor/Livedo (Livedo reticularis)
- Flushing
- Petechia
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| Edema |
- Peripheral edema
- Anasarca
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| Other |
- Rash
- Desquamation
- Induration
- Diaphoresis
- Mass (Neck mass)
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noco (i/b/d/q/u/r/p/m/k/v/f)/cong/tumr (n/e/d), sysi/epon
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proc, drug (D2/3/4/5/8/11)
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noco/cong/tumr, sysi/epon
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Immune disorders: hypersensitivity and autoimmune diseases (279.5–6)
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Type I/allergy/atopy
(IgE) |
| Foreign |
- Atopic eczema
- Allergic urticaria
- Allergic rhinitis (Hay fever)
- Allergic asthma
- Anaphylaxis
- Food allergy
- Milk
- Egg
- Peanut
- Tree nut
- Seafood
- Soy
- Wheat
- Penicillin allergy
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| Autoimmune |
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Type II/ADCC
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| Foreign |
- Pernicious anemia
- Hemolytic disease of the newborn
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| Autoimmune |
| Cytotoxic |
- Autoimmune hemolytic anemia
- Idiopathic thrombocytopenic purpura
- Bullous pemphigoid
- Pemphigus vulgaris
- Rheumatic fever
- Goodpasture's syndrome
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| "Type 5"/receptor |
- Graves' disease
- Myasthenia gravis
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Type III
(Immune complex) |
| Foreign |
- Henoch–Schönlein purpura
- Hypersensitivity vasculitis
- Reactive arthritis
- Farmer's lung
- Post-streptococcal glomerulonephritis
- Serum sickness
- Arthus reaction
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| Autoimmune |
- Systemic lupus erythematosus
- Subacute bacterial endocarditis
- Rheumatoid arthritis
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Type IV/cell-mediated
(T cells) |
| Foreign |
- Allergic contact dermatitis
- Mantoux test
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| Autoimmune |
- Diabetes mellitus type 1
- Hashimoto's thyroiditis
- Guillain–Barré syndrome
- Multiple sclerosis
- Coeliac disease
- Giant-cell arteritis
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| GVHD |
- Transfusion-associated graft versus host disease
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Unknown/
multiple |
| Foreign |
- Hypersensitivity pneumonitis
- Allergic bronchopulmonary aspergillosis
- Transplant rejection
- Latex allergy (I+IV)
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| Autoimmune |
- Sjögren's syndrome
- Autoimmune hepatitis
- Autoimmune polyendocrine syndrome
- Autoimmune adrenalitis
- Systemic autoimmune disease
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cell/phys/auag/auab/comp, igrc
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Drug reactions (Y40-Y59, E930-E949)
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Adverse drug reaction/
drug eruption |
- antibiotics: Penicillin drug reaction
- Sulfonamide hypersensitivity syndrome
- Urticarial erythema multiforme
- Adverse effects of fluoroquinolones
- hormones: Steroid acne
- Steroid folliculitis
- chemotherapy: Chemotherapy-induced acral erythema
- Chemotherapy-induced hyperpigmentation
- Scleroderma-like reaction to taxanes
- Hydroxyurea dermopathy
- Exudative hyponychial dermatitis
- blood: Anticoagulant-induced skin necrosis
- Warfarin necrosis
- Vitamin K reaction
- Texier's disease
- anticonvulsant: Anticonvulsant hypersensitivity syndrome
- water-balance/acid-base: Allopurinol hypersensitivity syndrome
- pulmonary: Leukotriene receptor antagonist-associated Churg–Strauss syndrome
- vaccine: Eczema vaccinatum
- other specified agents: Adverse reaction to biologic agents
- Adverse reaction to cytokines
- Bromoderma
- Halogenoderma
- Iododerma
- Red man syndrome
- Methotrexate-induced papular eruption
- unspecified agent: Acute generalized exanthematous pustulosis
- Bullous drug reaction
- Drug-induced acne
- Drug-induced angioedema
- Drug-related gingival hyperplasia
- Drug-induced lichenoid reaction
- Drug-induced lupus erythematosus
- Drug-induced nail changes
- Drug-induced pigmentation
- Drug-induced pseudolymphoma
- Drug-induced urticaria
- Fixed drug reaction
- Stevens–Johnson syndrome
- Injection site reaction
- Linear IgA bullous dermatosis
- Toxic epidermal necrolysis
- HIV disease-related drug reaction
- Photosensitive drug reaction
- Serum sickness-like reaction
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