DISORDERS AND/OR ADVERSE REACTIONS - 13.SKIN -DERMATOGICAL SYSTEM -SUMMARY
Drug Name:DISORDERS AND/OR ADVERSE REACTIONS - 13.SKIN -DERMATOGICAL SYSTEM -SUMMARY
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Adverse Reaction
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13. DISORDERS AND /OR ADVERSE REACTIONS - SKIN -DERMATOLOGICAL SYSTEM - SUMMARY
Refer - Other information
Contents
Adverse Reaction:
FACTS ON FINGER TIPS (MIMS)
2. TINEA CAPITIS (SCALP RINGWORM)
Salient Features
Definition
- An infection of the scalp hair with dermatophyte fungi
Epidemiology
- More common in children
- Spread may be through person-to person contact or through shared hairbrushes and combs
Pathophysiology
- The infection may spread from the centre of the scalp outward or, alternatively, from outside in.
- Local trauma of scalp skin- for example ,through scratching -helps the infection to spread
Clinical features
- The hair becomes brittle, resulting in patchy hair loss.
- Perifollicular papules, may be seen, and the hair broken in the follicular orifices look like black dots.
- Discoloration of hair.
- A well defined inflammatory scalp lesion. These lesions may present a solitary or multiple form
- The differential diagnosis includes alopecia areata and other inflammatory scalp lesions, such as psoriasis and eczema
Investigations
- Examination of the scalp with Woo’s light may show the characteristic blue-green florescence
- Send plucked hair for fungal microscopy. The presence of fungi is revealed by the finding of hyphae and spores
- Culture can also be carried out.
Management
- May be self-limiting
- Griseofulvin or itraconazole are the treatments of choice.
- Cultures should be repeated at monthly intervals until there isabsolute certainity that the infection has been cured.
Key Points
- Topical treatment should not be used in isolation
- Treatments should continue until mycological cure can be seen to have occurred
- Chronic infections may not fluoresce with Wood’s light
Contra-Indications:
FACTS ON FINGER TIPS (MIMS)
3. ACNE
Salient Features
Pathophysiology
- Acne is a disease of the sebaceous follicle
- There is an increased sebum excretion
- Colonisation of the pilosebaceous duct occurs with ‘Probionibacterium acnes’
- Acne may be a sign of Polycystic Ovarian Syndrome or Cushing’s Syndrome
- Severe acne fever and musculoskletal synptoms my indicate acne fulminans. This is caused by an immune reaction to P acnes
Clinical features
- Open comoedones (blackheads) and closed comedones (whiteheads)
- Papules , pustules, noddles or cysts
- Scarring, and an oily skin
- Remember to examine the chest and back as well the face
Management of mild acne
- Topical antibacterial/keratolytic such as benzoyl peroxide preparations, azelic acid
- Topical antibiotics such as erythromycin, clindamycin or tetracycline
- Topical retinoid and related preparations such as tretinoin, isotretinoin, adapalene
- Can be used or alone in combination
Management of moderate acne
- Oral antibiotics- tetracyclines, erythromycin, trimethoprim, plus a topical preparation
- Consider change of oral antibiotics if no improvement after three months
- Anti-androgen, such as cyproterone acetate, plus oestrogen, might be used in females
Management of severe acne
- If there is no nodulocystic acne with scarring, refer to a dermatologist for treatment with oral isotretinoin
Key Points
- Early recognition and treatment is important to prevent physical scarring and reduce psychological impact.
- Differentiate from rosacea, where there are no comedones and papules or pustules occur over an erythematous background with telangiectasia
Dosages/ Overdosage Etc:
FACTS ON FINGER TIPS (MIMS)
4. SCLERODERMA
(SYSTEMIC SCLEROSIS)
Salient Features
Definition
- Chronic disease of an unknown cause
- Main characteristics: diffuse fibrosis, degenerative changes and systemic vascular damage of the skin and internal organs
Epidemiology
- Forty percent of patients have diffuse cutaneous scleroderma and 60% have limited cutaneous scleroderma
Clinical features
- Symmetric swelling of the fingers and hands is often an early manifestation, with concurrent development of Raynaud’s phenomenon. As the disease progresses oedema is replaced by indurations, resulting in thick, hard hyperpigmented and tight skin
- Oesophageal dysfunction occurs in all patients leading to abnormal swallowing sensation, and can later result in gastroesophageal reflux disease
- Diffuse interstitial fibrosis of the lungs occurs in 70% of patients resulting in early impairment in gas exchange leading to external dyspepsia
- Myocardial fibrosis occurs in 70% of patients and leads to conduction defects and supraventricular arrhythmias.
- Renal involvement results in hypertension and renal failure
Investigations
- Usually diagnosed impaired oesophageal motility
- Chest X-ray is used to exclude other pathology
- Barium swallow demonstrates deposits of calcium around the fingers
Management
- There is no specific treatment but various drugs are of value in treating symptoms or organ systems such as ACE inhibitors for hypertension
Key Points
- GI disturbances (heart burn, dyspepsia) or respiratory complaints are occasionally the first manifestations of the disease
Other Information:
13. DISORDERS AND /OR ADVERSE REACTIONS - SKIN -DERMATOLOGICAL SYSTEM - SUMMARY
( Ref- Harrisons - Priniciples of Internal Medicine Ninth Edition )
1. Exfoliative dermatitis ( 241 )
2. Toxic epidermal necrolysis ( bullous ) (610)
3. Erythema multiforme or Steven Johnson syndrome ( 245 )
4. Erythema nodosum ( 244 )
5. Fixed dose eruption ( 386 )
6. Photodermatitis ( 260 )
7. Urticaria ( 245 )
8. Nonspecific rashes ( 386 )
9. Pigment changes ( hyperpigmentation ) ( 386 )
10. Alopecia ( 746 )
11. Purpura ( 245 )
12. Lichenoid eruptions ( 386 )
13. Eczema ( contact dermatitis ( 386 )
14. Acne (242)
1. Exfoliative dermatitis ( 241 )
Erthroderma syndrome ( exfoliative dermatitis ) is an important dermatological complication that may occur as the a result of an extension of a drug reaction, as generalized spreading of a preexiting dermatitis such as posriasis or atopic dermatitis, or in association with lymphoma and leukemia
Adverse reaction - drug ( 385 )
1. Exflioative dermatitis
2. Sulfonamides
3. Barbiturates
4. Phenytoin
5. Phenylbutazone
6. Gold salts
7. Quinidine
2. Toxic epidermal necrolysis ( bullous ) (610)
The syndrome may be localised or rarely generalized (toxic epidermal necrolysis, Ritters
syndrome, Lyells disease or scalded skin syndrome) . In the localized form staphylococci can usually be recovered from the bullous lesions, while in the generalized form they usually cannot be.
Adverse reaction - drug
1. Barbiturates
2. Phenylbutazone
3. Phenytoin
4. Sulfonamides
5. Phenolphthalein
6. Penicillins
7. Allopurinol
8. Iodides
9. Bromides
10. Nalidixic acid
3. Erythema multiforme or Steven Johnson syndrome ( 245 )
Eryhema multiforme syndrome is a characteristic response of the skin and mucous membranes that is related to a number of possible etiologies , including infectious agents and drugs ( especially penicillin, antipyretics , barbiturates, hydantoins and sulfonamides )
Adverse reaction - drug ( 386 )
1. Sulfonamides
2. Barbiturates
3. Phenylbutazone
4. Chlorpropamide
5. Thiazides
6. Sulfones
7. Phenytoin
8. Ethosuxide
9. Salicylates
10. Tetracyclines
11. Codeine
12. Penicillins
4. Erythema nodosum ( 244 )
The erythema nodusum syndrome refers to the occurence of multiple bilateral tender nodules appearing principally on the anterior aspect of the lower extremites and occassionally on the upper extremties and face. The erythema nodusum syndrome is associated with an number of disorders that are unrelated to each other.
Adverse reaction - drug ( 386 )
1. Penicillins
2. Sulfonamide
3. Oral contraceptives
5. Fixed dose eruption ( 386 )
Adverse reaction - drug
1. Phenolphthalein
2. Barbiturates
3. Sulfonamides
4. Salicylates
5. Phenybutazone
6. Quinine
6. Photodermatitis ( 260 )
The photodermatits involves a mild -to -serve erythematous reaction with or without vesicles or bulae. Dense postinflammatiory hyperpigmentation is visible within 3 to 5 days.Perfumes and colognes containing oil of bergamot are known to induce hyperpigmentation with or without eryhema
Adverse reaction - drug ( 386 )
1. Tetracyclines , particularly demeclocyline
2. Griseofulvin
3. Sulfonamides
4. Sulfonylureas
5. Thiazides
6. Furosemide
7. Phenothizines
8. Nalidixic acid
9. Oral contraceptives
10. Chlordiazepoxide
7. Urticaria ( 245 )
Urticaria is characterized by wheals of which the outstanding feature is their persistence for only a few hours . This short duration differentiates urticarial wheals from other almost identitical papules of erythema nultiforme , which persists for more than 1 or 2 days rather a few hours. An acute onset of urticaria is usually related to ingestion of drugs or certain types of foods ( such as shellfish, fresh berries)
Adverse reaction - drug ( 386 )
1. Aspirin
2. Penicillins
3. Sulfonamides
4. Barbiturates
8. Nonspecific rashes ( 386 )
Adverse reaction - drug
1. Ampicillin
2. Barbiturates
3. Allopurinol
4. Phenytoin
5. Methydopa
9. Pigment changes ( hyperpigmentation ) ( 386 )
Adverse reaction - drug
1. ACTH
2. Busulfan
3. Phenothiiziness
4. Hypervitaminosis A
5. Oral contraceptives
6. Gold salts
7. Chloroquine and other antimalarials
8. Cyclophosphamide
9. Bleomycin
10. Alopecia ( 746 )
Scalp dermatophytoxis ( tinea carpitis) is characterized by areas of alopecia and scaling.
Adverse reaction - drug ( 386 )
1. Cytotoxics
2. Ethionamide
3. Heparin
4. Oral contraceptives ( withdrawal )
11. Purpura ( 245 )
A purpuric eruption demands immediate exploration for its etiology. Purpura arises in the skin of the vasculrized dermis and is almost always confined to the dermis. The purpuric macules gradually disappears after days oe weeks, depending on their size
Adverse reaction - drug ( 386 )
1. Corticosteroids
2. Aspirin
12. Lichenoid eruptions ( 386 )
Adverse reaction - drug
1. Chlorpropamide
2. Gold salts
3. Antimalarials
4. PAS
5. Methyldopa
6. Phenothiazines
13. Eczema ( contact dermatitis ( 386 )
Adverse reaction - drug
1. Topical antimictobials
2. Topical local anesthetics
3. Topical antihistamines
4. Cream and lotion perservatives
5. Lanolin
14. Acne (242)
The major disease of the subaceous gland in humans is acne vulgaris which occurs predominantly on the face, and to a lesser degree, on the back, chest,and shoulders. It is characterized by a variety of clinical lesions. These lesions may be either noninflammatory or inflammatory papules and nodules. The noninflammatory papules are called omedones, and these may be either open (blackheads) or closed (whiteheads)
Adverse reaction - drug
1. Anabolic and androgenic steroids
2. Corticosteroids
3. Bromides
4. Iodides
5. Oral contraceptives
6. Isoniazid
7. Troxidone
Patient Information: