Chapter 056. Cutaneous Drug Reactions (Part 9)

Sulfonamides Antibacterial sulfonamides have a rather high risk of causing cutaneous eruptions and are among the drugs most frequently implicated in SJS and TEN. The combination of sulfamethoxazole and trimethoprim frequently induces adverse cutaneous reactions in patients with AIDS (Chap. 182). Desensitization is often successful in AIDS patients with morbilliform eruptions but is not recommended in AIDS patients who manifested erythroderma or a bullous reaction in response to their earlier sulfonamide exposure.Reaction rates are much lower with nonantibiotic sulfonamides, including diuretics or antidiabetic agents. Cross-reactivity between antibiotic and nonantibiotic sulfonamides is, at most, infrequent. ...
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Chapter 056. Cutaneous Drug Reactions (Part 9) Chapter 056. Cutaneous Drug Reactions (Part 9) Sulfonamides Antibacterial sulfonamides have a rather high risk of causing cutaneouseruptions and are among the drugs most frequently implicated in SJS and TEN.The combination of sulfamethoxazole and trimethoprim frequently inducesadverse cutaneous reactions in patients with AIDS (Chap. 182). Desensitization isoften successful in AIDS patients with morbilliform eruptions but is notrecommended in AIDS patients who manifested erythroderma or a bullousreaction in response to their earlier sulfonamide exposure. Reaction rates are much lower with nonantibiotic sulfonamides, includingdiuretics or antidiabetic agents. Cross-reactivity between antibiotic andnonantibiotic sulfonamides is, at most, infrequent. Vancomycin Vancomycin causes two unusual but recognizable cutaneous reactions:linear IgA bullous dermatosis (a transient blistering eruption) and red mansyndrome. Red man syndrome occurs during rapid IV infusion of vancomycin.This is thought to be a histamine-related anaphylactoid reaction characterized byflushing, diffuse maculopapular eruption, hypotension, and, in rare cases, cardiacarrest. Agents Used in Cancer Chemotherapy Since many agents used in cancer chemotherapy inhibit cell division,rapidly proliferating elements of the skin, including hair, mucous membranes, andappendages, are sensitive to their effects. As a result, stomatitis and alopecia areamong the most frequent dose-dependent side effects of chemotherapy. Variousnail abnormalities have been described: onycholysis, dystrophy, Beaus lines,white lines, and pigmentation. Sterile cellulitis and phlebitis and ulceration ofpressure areas occur with many of these agents. Also reported is acral erythema,which begins with dysesthesia followed by redness and a painful edematouseruption of the palms and soles; it is caused by cytarabine, doxorubicin,methotrexate, and 5-fluorouracil. Urticaria, angioedema, and exfoliative dermatitisalso have been seen, as has local and diffuse hyperpigmentation. Hypersensitivity to carboplatin or cisplatin is not rare (with an incidence of10–20%) among patients receiving multiple treatments with these drugs. It isprobably IgE mediated. Moderate to severe reactions including respiratory distressand hypotension are also observed in 10–20% of patients receiving paclitaxelregardless of premedication with glucocorticoids and histamine H(1) and H(2)antagonists. Glucocorticoids Both systemic and topical glucocorticoids cause a variety of skin changes,including acneiform eruptions, atrophy, striae, and other stigmata of Cushingssyndrome, and in sufficiently high doses can retard wound healing. Patients usingglucocorticoids are at higher risk for bacterial, yeast, and fungal skin infectionsthat may be misinterpreted as drug eruptions but are instead drug side effects.Allergy to glucocorticoids may also occur either as contact dermatitis to topicalformulations or as systemic reactions, including anaphylaxis. Biologic Therapies These include cytokines and monoclonal antibodies. Injection-site reactions are the most frequent adverse event. The severityvaries from mild redness to deep inflammation and necrosis. In most cases thetreatment can be continued and the severity of reactions will decrease with time. Like all foreign proteins, monoclonal antibodies may induce urticaria,angioedema, anaphylactic reactions, and serum sickness. Alopecia is a common complication of IFN-α. A nonspecific highly pruriticdermatitis is frequent in patients receiving IFN and ribavirin for hepatitis C. Induction or exacerbation of various immune-mediated disorders,especially lupus erythematosus, has been reported with many biologicals(interleukin 2, IFN-α, anti–tumor necrosis factor α). Granulocyte colony-stimulating factor may induce various neutrophilicdermatoses, including Sweets syndrome and pyoderma gangrenosum, and canexacerbate psoriasis. Cetuximab is a member of a new family of antineoplastic agents that inhibitthe EGF receptor. These molecules induce acneiform eruptions after a meaninterval of 10 days in a majority of patients. The severity of the eruption wasshown to correlate with a better anticancer effect. Systemic antibiotics and topicalanti-acne treatments are helpful. Although not usually classified as adverse drug reactions, skin infectionsand skin cancer could become a major concern with long-term use of immune-modifying biologicals. Antimalarial Agents Antimalarial agents are used as therapy for several skin diseases, includingthe skin manifesta ...