Hypersensitivity Reactions
Morbilliform Rash Stevens Johnson Toxic Epidermal Fixed Drug Reaction Erythema Nodosum
Necrolysis
Presentation Small, circular lesion Nikolsky sign Limited to single area Tender lesion
Target shaped Raised
Mucocutaneous necrosis Involved: Involved: Red-brown
Sepsis
Mucous Mucous
+/- mucous involvement Conjunctiva Conjunctiva Usually on leg
Respiratory (failure) Respiratory
Causes Penicillin Associated:
Rifampin Streptococcous
Sulfa Drugs (NSAIDs) Coccidioidomycoses
Antiepileptic (Phenytoin, carbamazepine) Histoplasmosis
Allopurinol Sarcoidosis
Quinidine Pregnancy
Herpes Inflammatory
Mycoplasm
Diagnosis
Skin biopsy
Treatments Stop offending agent Intravenous Immunoglobulins Topical steroids Underlying cause
Aspirin
<10% body SA (SJS) NSAIDs
>30% body SA (TEN) Corticosteroids
SEVERE
, Blistering Diseases
Pemphigus Vulgaris Bullous Pemphigoid Porphyria Cutanea Tarda
Presentation Painful Painful Bullous skin
Non-pruritic Non-pruritic Sun-exposed area
Diffuse, desquamating lesion Bullae intact a/w hypertrichosis
Broken bullae No oral involvement
Oral involvement Fluid loss uncommon
+/- Infection / Fluid loss Infection uncommon
Causes Autoimmune Light + abnormal prophyrin:
Drug Allergy - Hepatitis C
ACE inhibitors - Iron Overload
- Estrogen Use
Autoantibodies→ - Alcoholism
1) Epidermis: vulgaris
2) Epidemis/dermis: bullous
Diagnosis Biopsy High urine uroprohyrins
Direct immunofluorescence
Nickolsky sign (Vulgaris)
Treatment Prednisone Eliminate alcohol / E
Phlebotomy →
Steroid sparing Hydroxychloroquine
Cyclosporine
Azathioprine
, Fungal Infections
Ringworms Tinea Versicolor Candidiasis
Presentation Circular, ring sores Diffuse / Itchy Large, white plaques
Slightly red Large body area Easily scraped away
Scaly borders Patches: white, pink, red, brown Itchy, sticky exudate
Itchy Spots don’t tan
Hair loss Neck, chest & back MAINLY
Causes Tinea family Malassezia furfur Candida Albicans
Oily skin Antibiotics
(microscopy with KOH) Hot climate Steroid
Weak immune Pregnancy
Diagnosis
Spaghetti + meatball pattern
Fungal hyphae
Treatments Topical: (no hair/nail) Topical: Topical
- Clotrimazole - Clotrimazole - Clotrimazole
- Butenafine
Recurrent: Oral Fluconazole
Systemic: - Oral ketoconazole
- Itraconazole - Single dose
- Fluconazole (wkly for 3-6mn)
Morbilliform Rash Stevens Johnson Toxic Epidermal Fixed Drug Reaction Erythema Nodosum
Necrolysis
Presentation Small, circular lesion Nikolsky sign Limited to single area Tender lesion
Target shaped Raised
Mucocutaneous necrosis Involved: Involved: Red-brown
Sepsis
Mucous Mucous
+/- mucous involvement Conjunctiva Conjunctiva Usually on leg
Respiratory (failure) Respiratory
Causes Penicillin Associated:
Rifampin Streptococcous
Sulfa Drugs (NSAIDs) Coccidioidomycoses
Antiepileptic (Phenytoin, carbamazepine) Histoplasmosis
Allopurinol Sarcoidosis
Quinidine Pregnancy
Herpes Inflammatory
Mycoplasm
Diagnosis
Skin biopsy
Treatments Stop offending agent Intravenous Immunoglobulins Topical steroids Underlying cause
Aspirin
<10% body SA (SJS) NSAIDs
>30% body SA (TEN) Corticosteroids
SEVERE
, Blistering Diseases
Pemphigus Vulgaris Bullous Pemphigoid Porphyria Cutanea Tarda
Presentation Painful Painful Bullous skin
Non-pruritic Non-pruritic Sun-exposed area
Diffuse, desquamating lesion Bullae intact a/w hypertrichosis
Broken bullae No oral involvement
Oral involvement Fluid loss uncommon
+/- Infection / Fluid loss Infection uncommon
Causes Autoimmune Light + abnormal prophyrin:
Drug Allergy - Hepatitis C
ACE inhibitors - Iron Overload
- Estrogen Use
Autoantibodies→ - Alcoholism
1) Epidermis: vulgaris
2) Epidemis/dermis: bullous
Diagnosis Biopsy High urine uroprohyrins
Direct immunofluorescence
Nickolsky sign (Vulgaris)
Treatment Prednisone Eliminate alcohol / E
Phlebotomy →
Steroid sparing Hydroxychloroquine
Cyclosporine
Azathioprine
, Fungal Infections
Ringworms Tinea Versicolor Candidiasis
Presentation Circular, ring sores Diffuse / Itchy Large, white plaques
Slightly red Large body area Easily scraped away
Scaly borders Patches: white, pink, red, brown Itchy, sticky exudate
Itchy Spots don’t tan
Hair loss Neck, chest & back MAINLY
Causes Tinea family Malassezia furfur Candida Albicans
Oily skin Antibiotics
(microscopy with KOH) Hot climate Steroid
Weak immune Pregnancy
Diagnosis
Spaghetti + meatball pattern
Fungal hyphae
Treatments Topical: (no hair/nail) Topical: Topical
- Clotrimazole - Clotrimazole - Clotrimazole
- Butenafine
Recurrent: Oral Fluconazole
Systemic: - Oral ketoconazole
- Itraconazole - Single dose
- Fluconazole (wkly for 3-6mn)
