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. Dermatoses caused only by medicaments
Dug induced reactions
Dermatoses caused only by medicaments
Toxic epidermal necrolysis (TEN), Lyell syndrome)
Erythema perstans
Acute generalised exanthematous pustulosis (AGEP)
Pseudolymphoma

6. Drug-induced reactions
Dermatoses with different etiology
Utricaria
Erythema multiforme, nodosum
Purpura
Autoimmunological disorders:
- bullous diseases
- systemic lupus erythematosus

7. Drug-induced reactions
Morphology
Maculo-papular eruption
Hemorrhagic
Lichenoidal
Acneiforme
Vesicular and bullous
Pigmentous
Morfeiform
Necrotic
Pruritus
Hair and nails lesions

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
Type of reaction
Causative drug
Maculo-papular eruption
Aminopenicylines
Sulphonamides
NSAiDs
Anticonvulsants
Psuchotropics
Allopurinol
ACE inhibitors
beta-blockers

10. Drug-induced reaction
Type of reaction
Causative drug
Urticaria
Quincke edema
Antibiotics (penicillin)
Sulphonamides
Aspirin, NSAiDs
Heterologous serum
Insulin
Contrast medium
ACE inhibitors
Opiate

11. Drug-induced urticaria - mechanisms
Allergic urticaria
Cause
I mechanism G-C
2. III mechanism G-C
Pnc, pirazolons, sulphonamides
Sera, pnc, cephalosporins
Nonallergic urticaria
Cuase
Direct release of mediators
Idiosyncrasia
Inibition of inflammatory mediators inactivation
Contrast media (Iod), opiates, curara, polimyksine
Aspiryn, NSAiDs
ACE inhibitors
Angiotensines

12. Drug – induced reactions
Type
Causative drug
Erythemas
Erythema perstans
Erythema nodosum
Erythema multiforme / Stevens-Johnson syndrome
barbituranes, paracetamol,
sulphonamides, tetracyclines
antibiotics, sulphonamides,
NSAiDs, estrogens
NSAiDs, barbituranes, anticonvulsants

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
Type
cause
Haemorrhagic reaction
trombocytopathies
trombocytopenies
vasculitis
ASA
cytostatics
antibiotics
(beta-lactams, tetracyclines, streptomycine)
sulphonamides
NSAiDs
diuretic drugs
ACE inhibitors
beta-blockers
anticonvulsants

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
Type
Cause
Phototoxic, photoallergic
psolarens
sulphonamides
NSAiDs
tetracyclines
chinolones
thiazydes
furosemid
antimalarial
antidepressive
hormones

19. Photohypersensitivity
Typ reakcji
Obraz kliniczny
Phototoxic
Photoallergic
Sun burn like lesions
(only on sun exposed skin),
hiperpigmentations, lichenoid exanthemas, lupus-like, PCT
Eczema-like
(can be not only on sun exposed skin)

20. Drug-induced reactions
Type
Cause
Erythrodermia
barbiturans
carbamazepine
nitrofurantoin
NSAiDs
sulphonamides
thiazides

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