Description, Causes and Risk Factors:
Alternative Name: Drug eruption, medicinal eruption.
The term “drug eruption” or “dermatitis medicamentosa” refers to any eruption attributable to the action of a drug which reaches the skin by way of the blood stream, irrespective of the method by which it has been administered. The term does not apply to any local reaction which may occur as a result of direct contact of the drug with the skin from the outside.
Dermatitis medicamentosa present the most varied clinical manifestations, and all the primary skin lesions-erythema, papules, bullae, etc.-may result from drug action.
Dermatitis medicamentosa can appear on people of all ages, all races, and of both sexes. Among adults, women are more likely than men to develop drug eruptions, and they tend to occur more frequently in elderly people.
People may be more likely to have a dermatitis medicamentosa if they:
Have an infection.
Are taking more than 3 medicines daily.
Have a weakened immune system due to illness or medication
Although any medication can cause a rash, the most common types of medications that cause a dermatitis medicamentosa include:
Iodine, especially that found in X-ray contrast dye.
The characteristic lesion of an eruption due to a given drug may be totally different in one individual from that in another. Factors intimately connected with the reacting tissue must therefore operate in determining the nature of the response. There are thus two types of individual variation in response to drugs; one involving susceptibility to the pharmacological action and the other the variation in the incidence of untoward phenomena including skin eruptions, and so far as is known there is no correlating link between these two variables. As the capacity of the skin to vary its reactions to noxious agents is limited, the lesions presented by drug eruptions are similar to those seen in other skin diseases due to infections and intoxications or of unknown origin. In drug eruptions the disposition of the lesions with regard to each other, their course, and their duration differ in detail from that seen in other -forms of skin disease. In spite of this there is not infrequently a close similarity between drug eruptions and other dermatoses, and differential diagnosis may at times be difficult. It is possible that some of the eruptions which appear during the administration of a drug are not due to the direct effect of the drug on the skin but to the action of some toxin which has been liberated from the site of the disease under treatment or from some latent focus of infection. This mechanism is referred to as biotropism, and it would account for the close similarity between some eruptions attributed to drugs and those due to infections for example, the erythema nodosum reactions.
Drug eruptions can appear as various types of skin rashes, including pink-to-red bumps, hives, blisters, red patches, pus-filled bumps (pustules), but on occasion they may be accompanied byfever, blood changes, and asthma, all of whichcan be regarded as idiosyncratic responses comparablein nature to the eruption itself. In rare instances agrave systemic upset in association with skin manifestations may prove fatal for example, with organicarsenical preparations.
A detailed history is often required for diagnosis, including recent use of OTC drugs. Because the reaction may not occur until several days or even weeks after first exposure to the drug, it is important to consider all new drugs and not only the one that has been most recently started. No laboratory tests reliably aid diagnosis, although biopsy of affected skin is often suggestive.
In addition, the doctor may want to do blood tests and look for signs of an allergic reaction.
Extensive eruptions such as those due to gold, organic arsenical preparations, and some types of sulfonamide eruption should be treated in hospital when possible.
Prolonged rest in bed, careful nursing, and extensive local treatment are necessary, and the fluid intake must be well maintained.
Local applications are directed towards the relief of itching and the restoration of altered skin structure to normal and mildly astringent lotions and bland pastes or creams are suitable.
In the presence of lichenoid lesions, which are usually persistent in character superficial x-ray therapy is useful.
Most drug reactions resolve when drugs are stopped and require no further therapy.
Antihistamine drugs may relieve itching, but with the exception of urticarial reactions they do not benefit the eruption greatly, and it must be remembered that eruptions have been attributed with good reason to the antihistamine preparations themselves. Severe symptoms of collapse, dehydration, blood dyscrasias, and psychotic manifestation may accompany the eruption.
Disclaimer: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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