| What are cutaneous adverse drug reactions? | undesirable clinical manifestations to a drug, which include predictable or unanticipated side effects, with or without systemic involvement. | Cutaneous adverse drug reactions (cADR) are undesirable clinical manifestations to a drug, which include predictable or unanticipated side effects, with or without systemic involvement. COMMON TYPES OF cADR Angioedema/ Anaphylaxis* Erythema multiforme/ Stevens Johnson syndrome/ Toxic epidermal necrolysis Acute generalized exanthematous pustulosis Maculopapular/ Exanthematous reactions* Fixed drug eruption | 44 | definition | 0.980 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967367_cutaneous_part_b.pdf | Cutaneous adverse drug reactions (cADR) are undesirable clinical manifestations to a drug, which include predictable or unanticipated side effects, with or without systemic involvement. COMMON TYPES OF cADR Angioedema/ Anaphylaxis* Erythema multiforme/ Stevens Johnson syndrome/ Toxic epidermal necrolysis Acute generalized exanthematous pustulosis Maculopapular/ Exanthematous reactions* Fixed drug eruption | 1 | page=1,block=0 | 0.700 | valid |
| What does High doses for longer periods can increase the risk of? | sepsis and metabolic complications | Change according to culture results and avoid suspected drug class • Adjuvant systemic therapy (ideally within the first 24-72 hours of onset) ▶ The role of systemic steroids is limited to early phase of SJS/TEN. High doses for longer periods can increase the risk of sepsis and metabolic complications. However judicious use of Prednisolone 1-2 mg/kg or equivalent dose of intravenous Dexamethasone for 3-7 days may be of benefit ▶ Cyclosporine in a dose of 3-5 mg/kg for a period of 10-14 days (with monitoring) • If skin detachment >10% refer to a center with an ICU familiar with management of skin failure • If < 10% follow the treatment as described TERTIARY CARE • Admit in specialized units within dermatology wards if vitals are stable and follow secondary care treatment • Barrier nursing • If patient has SIRS/ sepsis or in shock, admit to ICU • Long term follow up will be required to address complications: ophthalmic, skin and respiratory tract involvement • Chest X- ray • ECG • Laboratory tests- CBC, LFT, KFT, electrolytes, magnesium, phosphate, lactate • Blood gas analysis • Microbiology- Pus culture from infected areas and blood culture • Skin biopsy- Not usually required unless the diagnosis is in doubt • Optional- In TEN, biopsy and direct immunofluorescence is useful to rule out SLE and pemphigus | 268 |
| What are some common types of cutaneous adverse drug reactions? | Angioedema/ Anaphylaxis* Erythema multiforme/ Stevens Johnson syndrome/ Toxic epidermal necrolysis Acute generalized exanthematous pustulosis Maculopapular/ Exanthematous reactions* Fixed drug eruption | Cutaneous adverse drug reactions (cADR) are undesirable clinical manifestations to a drug, which include predictable or unanticipated side effects, with or without systemic involvement. COMMON TYPES OF cADR Angioedema/ Anaphylaxis* Erythema multiforme/ Stevens Johnson syndrome/ Toxic epidermal necrolysis Acute generalized exanthematous pustulosis Maculopapular/ Exanthematous reactions* Fixed drug eruption | 207 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967367_cutaneous_part_b.pdf | COMMON TYPES OF cADR Angioedema/ Anaphylaxis* Erythema multiforme/ Stevens Johnson syndrome/ Toxic epidermal necrolysis Acute generalized exanthematous pustulosis Maculopapular/ Exanthematous reactions* Fixed drug eruption | 1 | page=1,block=0 | 0.700 | valid |
| What are the differential diagnoses for Stevens Johnson Syndrome and Toxic Epidermal Necrolysis? | Staphylococcal scalded skin syndrome, pemphigus | STEVENS JOHNSON SYNDROME (SJS) AND TOXIC EPIDERMAL NECROLYSIS (TEN) • Acute, severe mucocutaneous reactions associated with epidermal detachment and/ or tenderness, and widespread erythematous lesions with central dusky erythema or vesiculation often associated with high grade fever • Usually observed with aromatic anticonvulsants, allopurinol, nevirapine, abacavir, NSAIDs, co-trimoxazole • The classification of SJS, TEN is based on the extent of detachment • D/d-Staphylococcal scalded skin syndrome, pemphigus | 468 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967367_cutaneous_part_b.pdf | STEVENS JOHNSON SYNDROME (SJS) AND TOXIC EPIDERMAL NECROLYSIS (TEN) • Acute, severe mucocutaneous reactions associated with epidermal detachment and/ or tenderness, and widespread erythematous lesions with central dusky erythema or vesiculation often associated with high grade fever • Usually observed with aromatic anticonvulsants, allopurinol, nevirapine, abacavir, NSAIDs, co-trimoxazole • The classification of SJS, TEN is based on the extent of detachment • D/d-Staphylococcal scalded skin syndrome, pemphigus |
| What drugs are usually associated with Stevens Johnson Syndrome and Toxic Epidermal Necrolysis? | aromatic anticonvulsants, allopurinol, nevirapine, abacavir, NSAIDs, co-trimoxazole | STEVENS JOHNSON SYNDROME (SJS) AND TOXIC EPIDERMAL NECROLYSIS (TEN) • Acute, severe mucocutaneous reactions associated with epidermal detachment and/ or tenderness, and widespread erythematous lesions with central dusky erythema or vesiculation often associated with high grade fever • Usually observed with aromatic anticonvulsants, allopurinol, nevirapine, abacavir, NSAIDs, co-trimoxazole • The classification of SJS, TEN is based on the extent of detachment • D/d-Staphylococcal scalded skin syndrome, pemphigus | 308 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967367_cutaneous_part_b.pdf | STEVENS JOHNSON SYNDROME (SJS) AND TOXIC EPIDERMAL NECROLYSIS (TEN) • Acute, severe mucocutaneous reactions associated with epidermal detachment and/ or tenderness, and widespread erythematous lesions with central dusky erythema or vesiculation often associated with high grade fever • Usually observed with aromatic anticonvulsants, allopurinol, nevirapine, abacavir, NSAIDs, co-trimoxazole • The classification of SJS, TEN is based on the extent of detachment • D/d-Staphylococcal scalded skin syndrome, pemphigus |
| What is applied on sloughed off areas for skin care in secondary care? | Topical antibiotics (Mupirocin or Fucidin) | PRIMARY CARE • See primary care for drug rash with eosinophilia and systemic symptoms (DRESS) SECONDARY CARE • Assess vitals, stabilise the patient, nutrition and fluid replacement as appropriate • Local care for skin and mucosae • Skin care- dilute potassium permanganate baths/ saline compresses/ Chlorhexidine baths ▶ Detached epidermis can be left in situ and covered with non-adherent dressing (sterile vaseline gauze) ▶ Topical antibiotics (Mupirocin or Fucidin) on sloughed off areas ▶ Oral care- Rinse mouth with Chlorhexidine 2-3 times, soft paraffin on lips as needed, steroid mouth washes ▶ Eye care- refer to ophthalmologist • Antibiotics-broad spectrum antibiotics (in case of sepsis or secondary infection) to cover staph, strep and pseudomonas. | 426 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967367_cutaneous_part_b.pdf | PRIMARY CARE • See primary care for drug rash with eosinophilia and systemic symptoms (DRESS) SECONDARY CARE • Assess vitals, stabilise the patient, nutrition and fluid replacement as appropriate • Local care for skin and mucosae • Skin care- dilute potassium permanganate baths/ saline compresses/ Chlorhexidine baths ▶ Detached epidermis can be left in situ and covered with non-adherent dressing (sterile vaseline gauze) ▶ Topical antibiotics (Mupirocin or Fucidin) on sloughed off areas ▶ Oral care- Rinse mouth with Chlorhexidine 2-3 times, soft paraffin on lips as needed, steroid mouth washes |
| What is recommended for oral care in secondary care for drug rash with eosinophilia and systemic symptoms? | Rinse mouth with Chlorhexidine 2-3 times, soft paraffin on lips as needed, steroid mouth washes | PRIMARY CARE • See primary care for drug rash with eosinophilia and systemic symptoms (DRESS) SECONDARY CARE • Assess vitals, stabilise the patient, nutrition and fluid replacement as appropriate • Local care for skin and mucosae • Skin care- dilute potassium permanganate baths/ saline compresses/ Chlorhexidine baths ▶ Detached epidermis can be left in situ and covered with non-adherent dressing (sterile vaseline gauze) ▶ Topical antibiotics (Mupirocin or Fucidin) on sloughed off areas ▶ Oral care- Rinse mouth with Chlorhexidine 2-3 times, soft paraffin on lips as needed, steroid mouth washes ▶ Eye care- refer to ophthalmologist • Antibiotics-broad spectrum antibiotics (in case of sepsis or secondary infection) to cover staph, strep and pseudomonas. | 504 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967367_cutaneous_part_b.pdf | PRIMARY CARE • See primary care for drug rash with eosinophilia and systemic symptoms (DRESS) SECONDARY CARE • Assess vitals, stabilise the patient, nutrition and fluid replacement as appropriate • Local care for skin and mucosae • Skin care- dilute potassium permanganate baths/ saline compresses/ Chlorhexidine baths ▶ Detached epidermis can be left in situ and covered with non-adherent dressing (sterile vaseline gauze) ▶ Topical antibiotics (Mupirocin or Fucidin) on sloughed off areas ▶ Oral care- Rinse mouth with Chlorhexidine 2-3 times, soft paraffin on lips as needed, steroid mouth washes |
| What is used for skin care in secondary care for drug rash with eosinophilia and systemic symptoms? | dilute potassium permanganate baths/ saline compresses/ Chlorhexidine baths | PRIMARY CARE • See primary care for drug rash with eosinophilia and systemic symptoms (DRESS) SECONDARY CARE • Assess vitals, stabilise the patient, nutrition and fluid replacement as appropriate • Local care for skin and mucosae • Skin care- dilute potassium permanganate baths/ saline compresses/ Chlorhexidine baths ▶ Detached epidermis can be left in situ and covered with non-adherent dressing (sterile vaseline gauze) ▶ Topical antibiotics (Mupirocin or Fucidin) on sloughed off areas ▶ Oral care- Rinse mouth with Chlorhexidine 2-3 times, soft paraffin on lips as needed, steroid mouth washes ▶ Eye care- refer to ophthalmologist • Antibiotics-broad spectrum antibiotics (in case of sepsis or secondary infection) to cover staph, strep and pseudomonas. | 243 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967367_cutaneous_part_b.pdf | PRIMARY CARE • See primary care for drug rash with eosinophilia and systemic symptoms (DRESS) SECONDARY CARE • Assess vitals, stabilise the patient, nutrition and fluid replacement as appropriate • Local care for skin and mucosae • Skin care- dilute potassium permanganate baths/ saline compresses/ Chlorhexidine baths ▶ Detached epidermis can be left in situ and covered with non-adherent dressing (sterile vaseline gauze) ▶ Topical antibiotics (Mupirocin or Fucidin) on sloughed off areas ▶ Oral care- Rinse mouth with Chlorhexidine 2-3 times, soft paraffin on lips as needed, steroid mouth washes |
| What items are listed under “DRUG RASH WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS) SYNDROME”? | • Potentially life threatening systemic adverse reaction • Onset 2-6 weeks after start of drug intake (up to 12 weeks) • The rash may continue to progress weeks to months after discontinuation of the drug • Commonly observed with anticonvulsants, dapsone, allopurinol, abacavir, leflunomide, minocycline | DRUG RASH WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS) SYNDROME
• Potentially life threatening systemic adverse reaction • Onset 2-6 weeks after start of drug intake (up to 12 weeks) • The rash may continue to progress weeks to months after discontinuation of the drug • Commonly observed with anticonvulsants, dapsone, allopurinol, abacavir, leflunomide, minocycline | 67 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967367_cutaneous_part_b.pdf | • Potentially life threatening systemic adverse reaction • Onset 2-6 weeks after start of drug intake (up to 12 weeks) • The rash may continue to progress weeks to months after discontinuation of the drug • Commonly observed with anticonvulsants, dapsone, allopurinol, abacavir, leflunomide, minocycline | 1 | page=1,block=49 |
| Which drugs are commonly associated with systemic adverse reactions and rash? | anticonvulsants, dapsone, allopurinol, abacavir, leflunomide, minocycline | • Potentially life threatening systemic adverse reaction • Onset 2-6 weeks after start of drug intake (up to 12 weeks) • The rash may continue to progress weeks to months after discontinuation of the drug • Commonly observed with anticonvulsants, dapsone, allopurinol, abacavir, leflunomide, minocycline | 230 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967367_cutaneous_part_b.pdf | • Potentially life threatening systemic adverse reaction • Onset 2-6 weeks after start of drug intake (up to 12 weeks) • The rash may continue to progress weeks to months after discontinuation of the drug • Commonly observed with anticonvulsants, dapsone, allopurinol, abacavir, leflunomide, minocycline | 1 | page=1,block=49 | 0.700 | valid |