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, anticonvulsants |
| Urticaria/ angioedema | Often IgE mediated Onset within minutes of drug initiation |
β-lactam antibiotics, ACEIs |
| Fixed drug eruption | Hyperpigmented plaques that recur at same skin or mucosal site | NSAIDs, tetracycline, carbamazepine |
| Pustules | Acute generalized eczematous pustulosis (AGEP) Acneiform |
AGEP: antibiotics, calcium-channel blockers Acneiform: corticosteroids, sirolimus |
| Bullous | Flaccid blisters Tense blisters |
Flaccid blisters: captopril, penicillamine Tense blisters: furosemide, vancomycin |
| Cutaneous lupus erythematosus | Erythematous/scaly plaques in photodistribution | Hydrochlorothiazide, calcium-channel blockers, ACEIs |
| Stevens-Johnson syndrome (SJS) | Purpuric macules on face and trunk with <10% epidermal detachment, fever, stomatitis, ocular involvement | Antibacterial sulfonamides, oxicam NSAIDs, anticonvulsants, allopurinol |
| Toxic epidermal necrolysis (TEN) | Similar to SJS but >30% epidermal detachment | Antibacterial sulfonamides, oxicam NSAIDs, anticonvulsants, allopurinol |
| Organ-specific reactions | Clnical features | Implicated medications |
|---|---|---|
| Hematologic | Hemolytic anemia, thrombocytopenia, granulocytopenia | Penicillin, quinine, sulfonamides |
| Hepatic | Hepatitis, cholestatic jaundice | Para-aminosalicylic 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, monoclonal antibodies |
| Drug reaction with eosinophilia and systemic symptoms (DRESS) | Cutaneous eruption, fever, eosinophilia, hepatic dysfunction, lymphadenopathy | Anticonvulsants, sulfonamides, minocycline, allopurinol |
| Serum sickness | Urticaria, arthralgia, fever | Heterologous antibodies, infliximab |
| Systemic lupus erythematosus | Arthralgia, myalgias, fever, malaise | Hydralazine, procainamide, isoniazid |
| Vasculitis | Cutaneous or visceral vasculitis | Hydralazine, penicillamine, propylthiouracil |