Drug Reaction

A Drug Reaction/ Eruption usually appear within the first 2-3 weeks of starting a drug.

Some of the most common drug eruptions are

FIXED DRUG ERUPTION (FDE)

In this type of drug reaction a particular body site is repeatedly involved with each exposure to a particular drug, i.e. it is limited to a particular site.

Drugs causing FDE are- sulphonamides, antiepileptic drug (phenytoin), NSAIDS (pain medications), etc

It appears as circular or oval, reddish patch within 1-2 days of intake of the offending drug. It can be burning or itchy in nature. After few days it starts darkening in colour, and heals leaving behind pigmentation.

If rechallenged with the same agent, the same site becomes red again and heals with pigmentation.

Sites more commonly involved are: hands, feet, palms, soles, face, oral mucosa and around mouth.

ERYTHEMA MULTIFORME

This type of reaction can be caused by other factors also apart from drugs

Drugs: NSAIDS (e.g. aspirin)tetracycline’s, penicillin’s, anti-TB (rifampicin, PAS, isoniazid)

Infections: viral (herpes simplex), bacterial (streptococcal pharyngitis), TB
Rarely food additives, SLE, sarcoidosis, infectious mononucleosis, can be the triggering factors.

Lesions are multiform. Initially it will be reddish flat lesion and patch which becomes rapidly elevated with a dark centre. And within next few days, it progresses to typical bull eye type appearance or target lesions with three zones of from outside in bright redness, pale swelling, and dark red or grey at the centre. Erosions can be seen in mucosa of oral or genital area.

Sites most commonly involved are: palms, soles, extremities, oral and conjunctival mucosa, lips and glans penis.

Diagnosis

Diagnosis is based on history of evolution, drug intake, associated diseases, and appearance of the skin lesion.

Complications

Drug eruption such as Erythema multiform can sometimes rapidly progress to involve other parts to whole of the body, condition known as Steven Johnson syndrome and toxic epidermal necrosis. It’s a life threatening condition with severe skin maceration and massive fluid loss and has to be managed in an intensive care accordingly.

Treatment atSkin &You Clinic

• Offending agent has to diagnosed and patient should carry with them Adverse drug reaction card with them all time.
• Topical and oral short course steroid can be prescribed.
• Ocular antibiotic and moistening agents to be used for eye protection.
• Nutritional and electrolyte balance maintenance should be followed.
• In severe cases, of Steven-Johnson and TEN intensive care is advised.

Why kin & You Clinic for Drug Reaction?

We, at Skin & You Clinic, assess, examine and treat all dermatological conditions with utmost care and latest interventions available.