Severe Cutaneous Drug Reactions

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🌱 來自: Huppert’s Notes

Severe Cutaneous Drug Reactions🚧 施工中

Severe Cutaneous Drug Reactions

Can be life threatening due to profound insensible losses and resultant fluid and electrolyte shifts.

Stevens-Johnson syndrome (SJS) / Toxic epidermal necrolysis (TEN)

•   Pathophysiology: Life-threatening drug reaction with mucocutaneous involvement; common medication triggers include TMP-SMX, PCN, lamotrigine, carbamazepine, and allopurinol

•   Clinical features: Presents with painful “targetoid” lesions on the face, trunk, and extremities; can progress to dusky blisters with widespread skin sloughing (+Nikolsky sign); majority of patients have mucosal involvement (ocular, oral, genital). SJS <10% body surface area (BSA), SJS/TEN overlap 10–30% BSA, TEN >30% BSA.

•   Treatment: Discontinue suspected agents, early dermatology consultation (associated with improved outcomes), supportive care in ICU or burn unit if needed

Drug-induced hypersensitivity syndrome (DIHS)

•   Pathophysiology: Potentially life-threatening drug reaction (mortality 10%) associated with antiepileptic drugs (carbamazepine, lamotrigine, phenytoin), TMP-SMX, NSAIDs, minocycline, allopurinol, and abacavir

•   Clinical features: Presents most commonly with a morbilliform drug eruption with facial swelling (nasolabial folds); eosinophilia is NOT a requirement for diagnosis (although present in 90% of cases); may have fever, lymphadenopathy, and evidence of organ involvement (liver, kidney, heart, lungs)

•   Treatment: Discontinue suspected agents, prolonged systemic steroids

Acute generalized exanthematous pustulosis (AGEP)

•   Clinical features: Rapidly progressive morbilliform drug eruption with innumerable pinpoint sterile pustules; common drug triggers include penicillins, macrolides, CCBs, and radiocontrast dye

•   Treatment: Discontinue unnecessary medications, treat symptoms with oral antihistamines +/− topical steroids