Medical history (history of illness) represents an important component in the diagnosis of drug exanthema. Family history Social history Current anamnesis/systemic anamnesis (somatic and psychological complaints). What changes have you noticed in yourself? How long have these changes existed? Have you taken any medications recently? If yes, which ones? Are there any other possible triggering … Drug-induced Exanthem: Medical History
Skin and subcutaneous (L00-L99). Erythema exsudativum multiforme (synonyms: erythema multiforme, cocard erythema, disc rose) – acute inflammation occurring in the upper corium (dermis), resulting in typical cocard-shaped lesions; a minor and a major form are distinguished. Infection urticaria – strongly itchy wheals and redness of the skin after chronic infections. Infectious and parasitic diseases (A00-B99). … Drug-induced Exanthem: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by drug exanthema: Skin and subcutaneous (L00-L99). Acute generalized exanthematous pustulosis (AGEP) – pinhead-sized pustules. Drug reaction with eosinophilia and systemic symptoms (DRESS; DRESS syndrome; drug exanthem with eosinophilia (elevation of eosinophil granulocytes in the blood count) and systemic symptoms/with skin … Drug-induced Exanthem: Complications
Classification of drug exanthema. Drug reaction (type) Drug reaction description Type A reaction Toxic-pharmacological; dose-dependent and predictable. Type B reaction Allergic, pseudoallergic intolerance and idiosyncratic reactions, dose-independent Type C reaction Cumulative doses with long duration of use Type D reaction Carcinogenic (causing cancer), teratogenic (effects that can cause malformations in the unborn child) reactions; late-onset, … Drug-induced Exanthem: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body temperature, body weight, body height; further: Inspection (viewing). Skin and sclerae (white part of the eye) [leading symptom: exanthema (rash), especially macular (blotchy) or maculopapular (blotchy and with papules, i.e., vesicles)] Dermatological examination [due … Drug-induced Exanthem: Examination
2nd order laboratory parameters – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification. Skin tests: Prick test (detection of type 1 allergies) – a drop of an allergen extract is applied to the patient’s skin and then a lancet is used to prick the skin … Drug-induced Exanthem: Test and Diagnosis
Therapeutic target Improvement of symptomatology. Therapy recommendations Review of continuous medication due topossible effect on the existing disease; discontinuation of the triggering medication; testing of alternative medications, if necessary. Symptomatic therapy with systemic and local antihistamines, if necessary also with oral glucocorticoids. Recovery time of the skin: 2-6 weeks.
The following symptoms and complaints may occur together with drug exanthema: Leading symptom Exanthem (rash): Primarily macular (blotchy) or maculopapular (blotchy and with papules, i.e., vesicles; = maculopapular exanthema (MPE)) (Type IV allergy) (most common form); Other forms are: scarlatiniform (“reminiscent of scarlet fever“), ruebeoliform (“reminiscent of rubella“), morbilliform (“reminiscent of measles“), psorasiform (“reminiscent of … Drug-induced Exanthem: Symptoms, Complaints, Signs
Pathogenesis (disease development) The pathogenesis of hypersensitivity syndrome is not fully understood. It is probably multifactorial, partly toxic, partly immunogenic. The immunological reaction is caused by binding of reactive substances to endogenous receptors such as MHC molecules (Major Histocompatibility Complex; group of genes encoding proteins important for immune recognition, tissue compatibility in transplantation and immunological … Drug-induced Exanthem: Causes
General measures Review of continuous medication due topossible effect on existing disease; discontinuation of triggering medication; testing of alternative medication if necessary. Regular check-ups Regular medical checkups Diagnosis by an allergist (4-6 weeks after illness).
