Skin-nontumor / Clinical Dermatology

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Skin-nontumor / Clinical Dermatology

Other dermatoses

Drug reaction

Reviewer: Mowafak Hamodat, MB.CH.B, MSc., FRCPC, Eastern Health, St. Johns, Canada (see Reviewers page)
Revised: 25 July 2011, last major update July 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Description
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● May cause urticaria, erythema multiforme, erythema nodosum, folliculitis, pustules, purpura, hyperpigmentation or vasculitis
● Procainamide may induce SLE-like disease
● Anti-cancer drugs may cause acute necrotizing changes in sweat glands (neutrophilic eccrine hidradenitis or syringosquamous metaplasia)
● Drug induced coma may cause necrosis of eccrine sweat coils and other adnexae, also epidermis
● Other drugs causing cutaneous reactions include gold salts, thiazides, antimalarial drugs, color film developers, tetracycline, barbiturates, phenolphthalein
● Fixed drug reaction: repeated administration causes recurrence of red-brown patch in same location, variable bullae

Sites
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● Genitalia and face

Treatment
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● Discontinue drug

Clinical images
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14 year old boy with reaction due to sulfasalazine

31 year old man with CML and post-imatinib reaction

Micro description
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● Eosinophils and marked vascular wall thickening
● May cause granulomatous infiltrate
● Also vacuolar interface changes and often lymphocytic exocytosis, dyskeratotic keratinocytes, parakeratosis with eosinophils and plasma cells in dermis

Micro images
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Lichenoid drug reaction

Differential diagnosis
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● Lichen planus: different sites (flexor arms/legs, glans penis and mucous membranes), lasts 1-2 years, not associated with drug administration, no prominent eosinophils (Indian J Dermatol Venereol Leprol 2011;77:418)

Additional references
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● eMedicine

End of Skin-nontumor / Clinical Dermatology > Other dermatoses > Drug reaction

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