2.medikamentozni egzantemi.ppt
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drug eruptions
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are common.
may be fatal.
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I will present
1. approach
2. FDE - EM - TEN
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steps
of
ap
pro
ach
steps
of
ap
pro
ach
morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
morphological diagnosis
non-drug causeshistory
lists
elimination
symptomatic therapy
skin testsprovocation
prohibition
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
maculopapularrash
is the mostcommon form.maculopapular
rash
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
urticariais the secondmost common
form.
urticaria
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
lichenoideruption
may continue
for monthsafter the stop
of the drug.
lichenoideruption
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
acneiformeruption
this patient was
using cortisonefor post-traumatic
cerebral edema.
acneiform lesionsoccurred
as a side effect.
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
erythemanodosum
oral
contraceptivesmay be
the cause.
erythemanodosum
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
iododermais characterizedby vegetations.
iodide is presentin cough
remedies.
iodide is used as
an intravenousradiocontrast
media.
iododerma
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
any
elemantary lesion
anydistribution
any
course
cutaneous sideeffects of drugs
may simulate
almost everyskin diseases.
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
measles, rubella
etc. are alsomaculopapular
rashes.
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
urticaria
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
TBC, Behets
disease etc. alsocause erythema
nodosum.
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
URI, TB, Behets
disease etc. alsocause erythema
nodosum.
non-drug causesshould be
excluded for the
diagnosis of drugeruption.
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
be
patient
ask some drugsname by name
evaluate
time factors
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
time factorsshould be
evaluatedvery
carefully.week0-1-2-3-4-5
cerebral trauma
phenytoin for the first timefor the first timefor the first time
rash
0
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
time factorsshould be
evaluatedvery
carefully.week0-1-2-3-4-5
cerebral trauma
rash
0
phenytoin
a drug, which has not been used
before, usually causes an
eruption after a sensitizationperiod of several weeks.
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
time factorsshould be
evaluatedvery
carefully.week0-1-2-3-4-5
pyelonephritis
bactrim
relapse
bactrim
rash
0
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
time factorsshould be
evaluatedvery
carefully.week0-1-2-3-4-5
pyelonephritis
bactrim
relapse
bactrim
rash
0
a drug, which has been used
before, usually causes an
eruption immediately .
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
time factorsshould be
evaluatedvery
carefully.day0-1-2-3-4-5 daydayday
bactrim aspirin
rash
0
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
time factorsshould be
evaluatedvery
carefully.day0-1-2-3-4-5
bactrim aspirin
urticaria
0
if the eruption is urticaria, only
aspirin is the culprit, because
urticaria occurs within a day afterdrug intake.
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
time factorsshould be
evaluatedvery
carefully.day0-1-2-3-4-5
bactrim aspirin
maculo-
papular
0
if the eruption is maculopapular,
both drugs are the culprit,
because maculopapular rash maydelay for several weeks.
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
time factorsshould be
evaluatedvery
carefully.mo.0-1-2-3-4-5 mo.mo.mo.
captopril
angio-
edema
0
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
time factorsshould be
evaluatedvery
carefully.mo.0-1-2-3-4-5
captopril
angio-
edema
0
a drug, which has been used
safely for months even years, may
also cause a cutaneous sideeffect.
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
time factorsshould be
evaluatedvery
carefully.week0-1-2-3-4-5
ampicillinpreviouslysafeampicillinpreviouslysafeampicillinpreviouslysafe
uri
ampicillin
rash
0
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morphological
non-drughistory
lists
elimination
symptomatic
skin testsprovocation
prohibition
time factorsshould be
evaluatedvery
carefully.week0-1-2-3-4-5
safe
uri
ampicillin
rash
0
ampicillin, which has been used
safely before, may cause a rash in
the presence of infectiousmononucleosis.
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morphological
non-drughistory
lists
eliminationsymptomatic
skin testsprovocation
prohibition
thousands of
drugs
hunderds ofrash types
no oneremember
all of them !
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morphological
non-drughistory
lists
eliminationsymptomatic
skin testsprovocation
prohibition
thousands of
drugs
hunderds ofrash types
no oneremember
all of them !
a guide, which
contains previousexperiences,
should be used.
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morphological
non-drughistory
lists
eliminationsymptomatic
skin testsprovocation
prohibition
textbook
prospectus
internet
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morphological
non-drughistory
lists
eliminationsymptomatic
skin testsprovocation
prohibition
treatment
=cessationof drugs
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morphological
non-drughistory
lists
eliminationsymptomatic
skin testsprovocation
prohibition
treatment
=cessationof drugs
all non-vital drugs
should be
stopped !
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morphological
non-drughistory
lists
eliminationsymptomatic
skin testsprovocation
prohibition
if angioedema
occurs in a patientwho is using
vitamins,
even if there is an
evident non-drug
cause of urticaria,
all drugs should
be stoppedbecause of risk of
laryngeal edema.
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morphological
non-drughistory
lists
eliminationsymptomatic
skin testsprovocation
prohibition
do not say to a
patient that we
have stopped
all of yourdrugs. that is
the wholetreatment.
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morphological
non-drughistory
lists
eliminationsymptomatic
skin testsprovocation
prohibition
drugs for
symptomatic relief
should be prescribedaccording to the
morphologicaldiagnosis.
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morphological
non-drughistory
lists
eliminationsymptomatic
skin testsprovocation
prohibition
do not give an
order like that
in ject oneampu le of
cor t isone.
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morphological
non-drughistory
lists
eliminationsymptomatic
skin testsprovocation
prohibition
precise
diagnosis
=rechallengewith drugs
one by one
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morphological
non-drughistory
lists
eliminationsymptomatic
skin testsprovocation
prohibition
precise
diagnosis
=rechallengewith drugs
one by one
if there is risk fordeath,
provocation
should not bedone !
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morphological
non-drughistory
lists
eliminationsymptomatic
skin testsprovocation
prohibition
indirect
diagnosis
prick-patchtests
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morphological
non-drughistory
lists
eliminationsymptomatic
skin testsprovocation
prohibition
prick test detects
type I allergy to a
given substance.
prick test is
useful inurticarial
rashes.
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morphological
non-drughistory
lists
eliminationsymptomatic
skin testsprovocation
prohibition
patch test
detects type IVallergy to a given
substance.
patch test is
useful inmaculopapular
rashes.
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fixed drug eruption,erythema multiforme and
toxic epidermal necrolysiswill be briefly discussed in
the rest of the presentation.
fi d d ti
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fixed drug eruption
main elementary lesions are
round erythematous macules.
fi d d ti
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fixed drug eruption
these erythematous macules
leave hyperpigmentation.
fi d d ti
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fixed drug eruption
if the responsible drug is used
again, the macules redden.
fi d d ti
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fixed drug eruption
blisters may develop on the
active lesions.
fi d d ti
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fixed drug eruption
glans penis is commonly
involved.
fi d d ti
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fixed drug eruption
an erosion occurs after rupture.
it may look like a chancre.
fixed drug eruption
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fixed drug eruption
an erosion occurs after rupture.
it may look like a chancre.
remnants of bullaeindicates fixed eruption;
induration, syphilis.palpation should be done
with gloves !
erythema multiforme
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erythema multiforme
in the minor form
macules and papules,
erythema multiforme
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erythema multiforme
in the major form
bullae dominate.
erythema multiforme
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erythema multiforme
especially acral regions
and
erythema multiforme
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erythema multiforme
periorificial regions are involved:
mouth, eye, anogenital region.
erythema multiforme
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erythema multiforme
erythematous rings
with different hues
erythema multiforme
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erythema multiforme
target lesion
is pathognomonic.
erythema multiforme
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erythema multiforme
target lesions are seen both in
minor and major forms.
erythema multiforme
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erythema multiforme
erythema multiforme may
also be due to infections,especially herpes simplex.post-herpetic EM usually
has a recurrent course.
erythema multiforme
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erythema multiforme
Stevens-Johnsonsyndrome
bullae + mucosal lesions + fever
erythema multiforme
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erythema multiforme
there are sores
in the mouth and eyes.
toxic epidermal necrolysis
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toxic epidermal necrolysis
toxic epidermal necrolysis
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toxic epidermal necrolysis
there are generalized bullae and
widespread erosions.
toxic epidermal necrolysis
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toxic epidermal necrolysis
it looks like staphylococcal
scalded skin syndrome.
toxic epidermal necrolysis
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toxic epidermal necrolysis
targetoid and mucosal lesions are
usually enough for differentiation.
toxic epidermal necrolysis
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toxic epidermal necrolysis
a biopsy should be done
in doubtful cases.
toxic epidermal necrolysis
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toxic epidermal necrolysis
it is treated like a burn.
toxic epidermal necrolysis
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toxic epidermal necrolysis
unfortunately, the mortality rate
is almost 50%.
maculopapular rash
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maculopapular rash,
which is the mostcommon form of drug
eruptions, may progressto toxic epidermal
necrolysis, if thecausative is not stopped.
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