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Drug-induced cutaneous reactions

Drug-induced cutaneous reactions. Małgorzata Sokołowska-Wojdyło, MD, MSc, PhD Elżbieta Grubska-Suchanek MD, PhD Department of Dermatology, Venereology and Allergology, Medical University of Gdansk. Drug hypersensitivity.

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Drug-induced cutaneous reactions

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  1. Drug-induced cutaneous reactions Małgorzata Sokołowska-Wojdyło, MD, MSc, PhD Elżbieta Grubska-Suchanek MD, PhD Department of Dermatology, Venereology and Allergology, Medical University of Gdansk

  2. Drug hypersensitivity Not expected consequences of medicaments ordered in therapeutic doses in right indication. • in 2-6% of hospitalized patients • in 8% of other patients

  3. Drug-induced reactions • medicaments can be applied topically or systemic • different skin lesions; morphology depends from causal factors and mechnism of action • in 3-4% of hospitalized patients • in 5% of other patients

  4. Reasons of appearance the drug-induced reactions Personal characters: • Age and sex • Genetical predisposition • Some disorders The medicaments’ charcteristics: • Chemical structure • Additives • Long-lasting treatment, especially big doses • Long-lasting topical treatment

  5. Dug induced reactions

  6. Drug-induced reactions

  7. Drug-induced reactions

  8. Maculo-papular exanthemas 1st description: 1967 (after ampicillin) - about 5% of ampicillin treated patients Clinical morphology can imitate infectious disorders 1st symptomes: 5 days – 2 weeks after 1st tablet Positive patch test and blastic transformation test in some cases – IV mechanism G-C (?)

  9. Drug-induced reaction

  10. Drug-induced reaction

  11. Drug-induced urticaria - mechanisms

  12. Drug – induced reactions

  13. Lyells’ syndrome (TEN) • drugs ! • Very rare: infections, vaccines, chemical substances, graft versus host disease • Skin, mucosa of respiratory and digestive system • Complications: electrolites disturbances, secondary bacterial infections

  14. Drug-induced TEN (most often causative drugs) • anticonvulsants (fenytoin, carbamazepine) • pirazolones’ derivatives • sulphonamides • beta-lactams • chinolones • allopurinol

  15. Drug-induced reactions

  16. Vasculitis Systemic: skin, kidneys, lungs, heart, brain, digestive tract Classifications’ criteria: - etiopathogenesis - clinical picture - vessels anatomy - histopathological picture

  17. Allergic (leucoclastic) vasculitis • Hierergic purpur (polymorphous lesions ) • III mechanism G-C Causative factors: bakteria, viruses, fungi, protozoa, drugs, food

  18. Drug-induced reactions

  19. Photohypersensitivity

  20. Drug-induced reactions

  21. Caution! • anticonvulsants • sulphonamides • pirazolones • antibiotics (beta-lactams)

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