Sandbox 09232014
| Cutaneous Reactions | Clnical Features | Implicated Medications |
|---|---|---|
| Exanthems | Delayed-type hypersensitivity Evolve over days after drug initiation Diffuse macules and papules |
Aminopenicillins, antibacterial sulfonamides, cephalosporins, allopurinol, antiepileptic agents |
| Urticaria/ angioedema | Often IgE mediated Onset within minutes of drug initiation and potential for anaphylaxis |
IgE mediated: β-lactam antibiotics Bradykinin mediated: ACE-Is |
| Fixed drug eruption | Hyperpigmented plaques Recur at same skin or mucosal site |
Tetracyline, NSAIDs, and carbamezapine |
| Pustules | Acneiform Acute generalized eczematous pustulosis (AGEP) |
Acneiform: corticosteroids, sirolimus AGEP: antibiotics, calcium-channel blockers |
| Bullous | Tense blisters Flaccid blisters |
Furosemide, vancomycin Captopril, penicillamine |
| SJS | Fever, erosive stomatitis, ocular involvement, purpuric macules on face and trunk with <10% epidermal detachment | Antibacterial sulfonamides, anticonvulsants, oxicam NSAIDs, and allopurinol |
| TEN | Similar features as SJS but >30% epidermal detachment Mortality as high as 50% |
Same as SJS |
| Cutaneous lupus | Erythematous/scaly plaques in photodistribution | Hydrochlorothiazide, calcium-channel blockers, ACE-Is |
| Extracutaneous Reactions | Clnical Features | Implicated Medications |
|---|---|---|
| Hematologic | Hemolytic anemia, thrombocytopenia, granulocytopenia | Penicillin, quinine, sulfonamides |
| Hepatic | Hepatitis, cholestatic jaundice | Para-aminosalacylic acid, sulfonamides, phenothiazines |
| Pulmonary | Pneumonitis, fibrosis | Nitrofurantoin, bleomycin, methotrexate |
| Renal | Interstitial nephritis, membranous glomerulonephritis | Penicillin, sulfonamides, gold, penicillamine, allopurinol |
| Multiorgan Reactions | Clnical Features | Implicated Medications |
|---|---|---|
| Anaphylaxis | Urticaria, angioedema, bronchospasm, gastrointestinal symptoms, hypotension IgE- and non–IgE-dependent reactions |
β-lactam antibiotics, mAbs |
| DRESS | Cutaneous eruption, fever, eosinophilia, hepatic dysfunction, lymphadenopathy | Anticonvulsants, sulfonamides, minocycline, allopurinol |
| Serum Sickness | Arthralgias, myalgias, fever, malaise | Hydralazine, procainamide, isoniazid |
| Vasculitis | Cutaneous or visceral vasculitis | Hydralazine, penicillamine, propylthiouracil |