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Adverse Cutaneous Reactions to Drugs

Adverse Cutaneous Reactions to Drugs. Michael Bigby, MD Department of Dermatology Harvard Medical School and Beth Israel Deaconess Medical School Boston, MA mbigby@bidmc.harvard.edu. Common Drug Rashes. Exanthem Urticaria Fixed-drug eruption. Serious Drug Rashes.

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Adverse Cutaneous Reactions to Drugs

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  1. Adverse Cutaneous Reactions to Drugs • Michael Bigby, MD • Department of Dermatology • Harvard Medical School and • Beth Israel Deaconess Medical School • Boston, MA • mbigby@bidmc.harvard.edu

  2. Common Drug Rashes • Exanthem • Urticaria • Fixed-drug eruption

  3. Serious Drug Rashes • Toxic epidermal necrolysis • Stevens-Johnson syndrome • Drug hypersensitivity syndrome

  4. Drug Hypersensitivity Syndrome • Exanthem • Fever • Hepatitis

  5. Identifying Culprit Drug • Timing • Rates of reactions • Response to withdrawal • Re-challenge

  6. Timing • 1 to 3 days • Up to 2 weeks (antibiotics and allopurinol)

  7. Determining Rates of Reactions • Prospectively collected data • Retrospective studies • Spontaneous reports/consumption

  8. Quality of Studies • Well-defined, representative sample • Sufficiently long and complete follow-up • Methods of linking drug and rash described • Correct temporal relationship • Rates calculable • Confidence intervals calculable

  9. Common Exanthem Producers • Amoxicillin • Ampicillin • Augmentin • Cephaclor • Co-trimoxazole • Penicillins • Red blood cells • Cephalosporins • Gentamicin • Floroquinolones

  10. Common Urticaria Producers • Same as exanthem producers • Histamine releasers

  11. Common Fixed-drug Producers • Co-trimoxazole • Naproxen • Dipyrone • Oxicams • Tetracyclines • Phenolphthalein

  12. Drugs Implicated in TEN and SJS • Hydantoins • Sulfonamides • NSAIDS • Allopurinol

  13. Drugs Implicated in Hypersensitivity • Hydantoins • Anti-epileptics • Sulfonamides

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