Internal Medicine

P1: RLJ/OZN P2: KUF

0521779407-D-01 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:41

Drug Eruptions 505

lesions especially pustules, papules and whiteheads, often worse

on trunk, onset weeks. Toxic pustuloderma as part of the drug

hypersensitivity syndrome (see below). 5 days – 6 weeks, range

3 +months.

➣Erythrodermic– widespread skin involvement with erythema,

scaling, and serous exudates; onset usually gradual starting at

1–6 weeks, range to 3+months.

➣Eczematous/Dermatitic– erythematous and scaling; onset 5

days – 3+months.

➣Blistering– fluid-filled lesions >5 mm, epidermal shedding.

Include Stevens-Johnson syndrome/toxic epidermal necrolysis,

which involve mucous membranes (mouth, eyes)+/−atypical

target lesions (dusky center with erythematous surrounds, may

blister centrally); onset 5–21 days, range 6+weeks. Other causes

of drug-induced blistering: porphyria, pseudoporphyria, linear

IgA disease, and pemphigus.

➣Fixed Drug Eruption– single or multiple round to oval

lesions, dusky red+/−edematous or central blister; resolves

with hyperpigmentation; classic sites periorificial, genital, and

perianal areas, onset 30 minutes – 2 days, range minutes –

4 days.

➣Vasculitic– palpable purpura, urticarial plaques, hemorrhagic

bullae, ulcers, dermal nodules, Raynaud’s disease, and digital

necrosis; onset 5 – 21 days, range 3+months.

■DISTRIBUTION and EXTENT – e.g., sharply demarcated photodis-

tributed eruption; involvement of dependent regions (legs and but-

tocks) in cutaneous vasculitis

■SYSTEMIC INVOLVEMENT: Commonly affected internal organs –

liver, kidneys, lungs, and hematological system. Features suggestive

of severe drug reaction+/−internal organ involvement:

➣Fever, pharyngitis, anorexia, and malaise or signs and symptoms

of internal organ involvement

➣Erythroderma

➣Prominent facial involvement+/−edema or swelling

➣Mucous membrane involvement (particularly if erosive or

involving conjunctiva)

➣Lymphadenopathy

➣Skin tenderness, blistering or shedding

➣Purpura

➣Drug Hypersensitivity Syndrome=Rash+Fever+Internal

Organ Involvement