HAIR DISORDERS
Hair disorders are amongst the common skin problems affecting all class of population at one or another time. Commonest of them are briefly mentioned here.
1) ALOPECIA AREATA:
Definition and clinical features
A non-scarring auto immune disorder affecting any hair-bearing area. Typically, there is a sudden onset of solitary or multiple circular or oval bald areas,usually affecting the scalp.The residual hair follicles are visible confirming a lack of scarring.Diagnostic exclamation mark hairs may be visible at the margins of the lesion. The affected scalp is usually normal in color but may be erythematous.Hairs at the edge of the patch may be easily removed on slight traction. Spontaneous regrowth frequently occurs but the areas may spread peripherally and may eventually involve the whole scalp( Alopecia Totalis) and sometimes even facial & body hairs( Alopecia Universalis).
Rarely, a diffuse alopecia may be seen without discrete bald patches.Nail changes may also occur as fine regular pitting or a roughened sand paper appearance(Trachyonychia).
Epidemiology
A common disorder affecting all races and either sex equally. It occurs at any age,with maximum incidence between 10-30 years.
Differential Diagnosis
Fungal infection of scalp—may be confirmed by Wood’s light and mycological examination.Trichotillomania—shows broken hairs of varying length.Telogen effluvium also causes diffuse non-scarring alopecia.
Investigations
An autoimmune basis is suggested.Organ specific antibodies may be demonstrated. A family history of alopecia areata occurs in 20-50% of patients. Scalp biopsy is supportive.
Management
Spontaneous regrowth may occur in localized disease.Topical,intralesional & systemic corticosteroids can produce temporary regrowth.Contact sensitization therapy using irritants or allergens & PUVA are also used. The more extensive the hair loss, the less likely the prospect of regrowth.Extensive involvement, atopy, other autoimmune diseases, nail involvement and onset in childhood are poor prognostic factors.
2) TELOGEN EFFLUVIUM:
Definition and clinical features
Sudden extensive hair loss occurring 4-8 weeks following the precipitating event. Several hundred hairs may be lost per day, producing an alopecia diffusely affecting the entire scalp.Pre-existing androgenetic alopecia may become more evident, the scalp appears normal and duration is variable(recovery is usually complete within 6 months).
Epidemiology
Occurs at any age but most frequently in young adults.Female:Male ratio is 2:1.
Differential Diagnosis
Diffuse scalp alopecia can also occur with alopecia areata, hypothyroidism,iron deficiency,anaemia,and may be caused by drugs.
Investigations
Trichogram (plucked scalp hairs) will show an increase in the number of telogen hairs and reduction in anagen hairs.
Special points
Acute precipitating factors include childbirth,pyrexia, haemorrhage,changing or discontinuing hormonal therapy(including oral contraceptive pills),eating disorders,strict dieting and nutritional deficiencies.
3) ANDROGENETIC ALOPECIA(MALE PATTERN BALDNESS):
Definition and clinical features
Miniaturisation of hair follicle through successive cycles affecting the fronto-vertex and crown of the scalp, producing a gradual conversion of terminal to villus hairs. The scalp hair loss begins with recession at the temples and the frontal hairline in men(Hamilton pattern) and thinning over the crown and vertex. This slowly progresses over years, in severe cases hair remains at the occiput and sides of the scalp alone.Vellus hair may remain on the vertex.In women(Ludwig pattern) the frontal hairline is frequently kept but a difuse thinning occurs over the top of the scalp.In women, associated hirsutism,acne vulgaris,obesity and irregular menses may suggest an underlying polycystic ovarian syndrome.
Epidemiology
Affects all races world wide, occurring physiologically from the late teens to the 50s.In women, occurs usually post menopausally.The condition requires genetic predisposition and normal amounts of circulating plasma androgens.
Differential Diagnosis
Telogen effluvium may produce diffuse alopecia but usually affects the back and sides of the scalp as well as the fronto-vertex.Hair styles producing traction may cause recession of the anterior hair margin.
Investigations
In women,hormone profile and ovarian ultrasound scan may confirm underlying polycystic ovarian syndrome.
Management
Treatment includes topical measures such as Minoxidil lotion, systemic antiandrogens in women or scalp reduction or hair transplantation surgery.
4) TRICHOTILLOMANIA:
Definition and clinical features
Self-induced alopecia produced by deliberate trauma to the hair. A diffuse area of thinned hair with a poorly defined margin.Scalp skin is normal.Affected hairs show breakage of varying lengths.The area may be solitary or multiple. A normal,long haired margin often remains.The scalp is usually affected but hair loss may also occur in the eyebrows, eyelashes or body hair.
Epidemiology
Trichotillomaia occurs more frequently in females than males(3:1) but may occur at any age.Most frequently it occurs between the ages of ages of 5 & 10 years developing as a habit tic.In older women it may be a sign of underlying psychiatric disorder.Anxiety & emotional stress are precipitating factors.
Differential Diagnosis
Alopecia areata produces more discrete,completely bald areas of patches.Tinea capitis can produce broken hairs,scaling and inflammation may be present.
Investigations
Hair microscopy will reveal broken hairs of varying lengths.
Management
Occlusion of the area often allows recovery.Children frequently outgrow the habit tic,whilst in adults psychiatric therapy may be required.
BY:
DR CHETAN LALSETA
M.D.(SKIN & V.D.)
CONSULTANT DERMATOLOGIST & COSMETOLOGIST
MIRROR LASER & COSMETIC CENTRE,
SHRADDHA HOSPITAL,
INDIRA CIRCLE CHOWK,
RAJKOT-04
CONTACT NO: 98251 99585
Chetanlalseta@gmail.com
Friday, March 20, 2009
HAIR DISORDERS
HAIR DISORDERS
Hair disorders are amongst the common skin problems affecting all class of population at one or another time. Commonest of them are briefly mentioned here.
1) ALOPECIA AREATA:
Definition and clinical features
A non-scarring auto immune disorder affecting any hair-bearing area. Typically, there is a sudden onset of solitary or multiple circular or oval bald areas,usually affecting the scalp.The residual hair follicles are visible confirming a lack of scarring.Diagnostic exclamation mark hairs may be visible at the margins of the lesion. The affected scalp is usually normal in color but may be erythematous.Hairs at the edge of the patch may be easily removed on slight traction. Spontaneous regrowth frequently occurs but the areas may spread peripherally and may eventually involve the whole scalp( Alopecia Totalis) and sometimes even facial & body hairs( Alopecia Universalis).
Rarely, a diffuse alopecia may be seen without discrete bald patches.Nail changes may also occur as fine regular pitting or a roughened sand paper appearance(Trachyonychia).
Epidemiology
A common disorder affecting all races and either sex equally. It occurs at any age,with maximum incidence between 10-30 years.
Differential Diagnosis
Fungal infection of scalp—may be confirmed by Wood’s light and mycological examination.Trichotillomania—shows broken hairs of varying length.Telogen effluvium also causes diffuse non-scarring alopecia.
Investigations
An autoimmune basis is suggested.Organ specific antibodies may be demonstrated. A family history of alopecia areata occurs in 20-50% of patients. Scalp biopsy is supportive.
Management
Spontaneous regrowth may occur in localized disease.Topical,intralesional & systemic corticosteroids can produce temporary regrowth.Contact sensitization therapy using irritants or allergens & PUVA are also used. The more extensive the hair loss, the less likely the prospect of regrowth.Extensive involvement, atopy, other autoimmune diseases, nail involvement and onset in childhood are poor prognostic factors.
2) TELOGEN EFFLUVIUM:
Definition and clinical features
Sudden extensive hair loss occurring 4-8 weeks following the precipitating event. Several hundred hairs may be lost per day, producing an alopecia diffusely affecting the entire scalp.Pre-existing androgenetic alopecia may become more evident, the scalp appears normal and duration is variable(recovery is usually complete within 6 months).
Epidemiology
Occurs at any age but most frequently in young adults.Female:Male ratio is 2:1.
Differential Diagnosis
Diffuse scalp alopecia can also occur with alopecia areata, hypothyroidism,iron deficiency,anaemia,and may be caused by drugs.
Investigations
Trichogram (plucked scalp hairs) will show an increase in the number of telogen hairs and reduction in anagen hairs.
Special points
Acute precipitating factors include childbirth,pyrexia, haemorrhage,changing or discontinuing hormonal therapy(including oral contraceptive pills),eating disorders,strict dieting and nutritional deficiencies.
3) ANDROGENETIC ALOPECIA(MALE PATTERN BALDNESS):
Definition and clinical features
Miniaturisation of hair follicle through successive cycles affecting the fronto-vertex and crown of the scalp, producing a gradual conversion of terminal to villus hairs. The scalp hair loss begins with recession at the temples and the frontal hairline in men(Hamilton pattern) and thinning over the crown and vertex. This slowly progresses over years, in severe cases hair remains at the occiput and sides of the scalp alone.Vellus hair may remain on the vertex.In women(Ludwig pattern) the frontal hairline is frequently kept but a difuse thinning occurs over the top of the scalp.In women, associated hirsutism,acne vulgaris,obesity and irregular menses may suggest an underlying polycystic ovarian syndrome.
Epidemiology
Affects all races world wide, occurring physiologically from the late teens to the 50s.In women, occurs usually post menopausally.The condition requires genetic predisposition and normal amounts of circulating plasma androgens.
Differential Diagnosis
Telogen effluvium may produce diffuse alopecia but usually affects the back and sides of the scalp as well as the fronto-vertex.Hair styles producing traction may cause recession of the anterior hair margin.
Investigations
In women,hormone profile and ovarian ultrasound scan may confirm underlying polycystic ovarian syndrome.
Management
Treatment includes topical measures such as Minoxidil lotion, systemic antiandrogens in women or scalp reduction or hair transplantation surgery.
4) TRICHOTILLOMANIA:
Definition and clinical features
Self-induced alopecia produced by deliberate trauma to the hair. A diffuse area of thinned hair with a poorly defined margin.Scalp skin is normal.Affected hairs show breakage of varying lengths.The area may be solitary or multiple. A normal,long haired margin often remains.The scalp is usually affected but hair loss may also occur in the eyebrows, eyelashes or body hair.
Epidemiology
Trichotillomaia occurs more frequently in females than males(3:1) but may occur at any age.Most frequently it occurs between the ages of ages of 5 & 10 years developing as a habit tic.In older women it may be a sign of underlying psychiatric disorder.Anxiety & emotional stress are precipitating factors.
Differential Diagnosis
Alopecia areata produces more discrete,completely bald areas of patches.Tinea capitis can produce broken hairs,scaling and inflammation may be present.
Investigations
Hair microscopy will reveal broken hairs of varying lengths.
Management
Occlusion of the area often allows recovery.Children frequently outgrow the habit tic,whilst in adults psychiatric therapy may be required.
BY:
DR CHETAN LALSETA
M.D.(SKIN & V.D.)
CONSULTANT DERMATOLOGIST & COSMETOLOGIST
MIRROR LASER & COSMETIC CENTRE,
SHRADDHA HOSPITAL,
INDIRA CIRCLE CHOWK,
RAJKOT-04
CONTACT NO: 98251 99585
Chetanlalseta@gmail.com
Hair disorders are amongst the common skin problems affecting all class of population at one or another time. Commonest of them are briefly mentioned here.
1) ALOPECIA AREATA:
Definition and clinical features
A non-scarring auto immune disorder affecting any hair-bearing area. Typically, there is a sudden onset of solitary or multiple circular or oval bald areas,usually affecting the scalp.The residual hair follicles are visible confirming a lack of scarring.Diagnostic exclamation mark hairs may be visible at the margins of the lesion. The affected scalp is usually normal in color but may be erythematous.Hairs at the edge of the patch may be easily removed on slight traction. Spontaneous regrowth frequently occurs but the areas may spread peripherally and may eventually involve the whole scalp( Alopecia Totalis) and sometimes even facial & body hairs( Alopecia Universalis).
Rarely, a diffuse alopecia may be seen without discrete bald patches.Nail changes may also occur as fine regular pitting or a roughened sand paper appearance(Trachyonychia).
Epidemiology
A common disorder affecting all races and either sex equally. It occurs at any age,with maximum incidence between 10-30 years.
Differential Diagnosis
Fungal infection of scalp—may be confirmed by Wood’s light and mycological examination.Trichotillomania—shows broken hairs of varying length.Telogen effluvium also causes diffuse non-scarring alopecia.
Investigations
An autoimmune basis is suggested.Organ specific antibodies may be demonstrated. A family history of alopecia areata occurs in 20-50% of patients. Scalp biopsy is supportive.
Management
Spontaneous regrowth may occur in localized disease.Topical,intralesional & systemic corticosteroids can produce temporary regrowth.Contact sensitization therapy using irritants or allergens & PUVA are also used. The more extensive the hair loss, the less likely the prospect of regrowth.Extensive involvement, atopy, other autoimmune diseases, nail involvement and onset in childhood are poor prognostic factors.
2) TELOGEN EFFLUVIUM:
Definition and clinical features
Sudden extensive hair loss occurring 4-8 weeks following the precipitating event. Several hundred hairs may be lost per day, producing an alopecia diffusely affecting the entire scalp.Pre-existing androgenetic alopecia may become more evident, the scalp appears normal and duration is variable(recovery is usually complete within 6 months).
Epidemiology
Occurs at any age but most frequently in young adults.Female:Male ratio is 2:1.
Differential Diagnosis
Diffuse scalp alopecia can also occur with alopecia areata, hypothyroidism,iron deficiency,anaemia,and may be caused by drugs.
Investigations
Trichogram (plucked scalp hairs) will show an increase in the number of telogen hairs and reduction in anagen hairs.
Special points
Acute precipitating factors include childbirth,pyrexia, haemorrhage,changing or discontinuing hormonal therapy(including oral contraceptive pills),eating disorders,strict dieting and nutritional deficiencies.
3) ANDROGENETIC ALOPECIA(MALE PATTERN BALDNESS):
Definition and clinical features
Miniaturisation of hair follicle through successive cycles affecting the fronto-vertex and crown of the scalp, producing a gradual conversion of terminal to villus hairs. The scalp hair loss begins with recession at the temples and the frontal hairline in men(Hamilton pattern) and thinning over the crown and vertex. This slowly progresses over years, in severe cases hair remains at the occiput and sides of the scalp alone.Vellus hair may remain on the vertex.In women(Ludwig pattern) the frontal hairline is frequently kept but a difuse thinning occurs over the top of the scalp.In women, associated hirsutism,acne vulgaris,obesity and irregular menses may suggest an underlying polycystic ovarian syndrome.
Epidemiology
Affects all races world wide, occurring physiologically from the late teens to the 50s.In women, occurs usually post menopausally.The condition requires genetic predisposition and normal amounts of circulating plasma androgens.
Differential Diagnosis
Telogen effluvium may produce diffuse alopecia but usually affects the back and sides of the scalp as well as the fronto-vertex.Hair styles producing traction may cause recession of the anterior hair margin.
Investigations
In women,hormone profile and ovarian ultrasound scan may confirm underlying polycystic ovarian syndrome.
Management
Treatment includes topical measures such as Minoxidil lotion, systemic antiandrogens in women or scalp reduction or hair transplantation surgery.
4) TRICHOTILLOMANIA:
Definition and clinical features
Self-induced alopecia produced by deliberate trauma to the hair. A diffuse area of thinned hair with a poorly defined margin.Scalp skin is normal.Affected hairs show breakage of varying lengths.The area may be solitary or multiple. A normal,long haired margin often remains.The scalp is usually affected but hair loss may also occur in the eyebrows, eyelashes or body hair.
Epidemiology
Trichotillomaia occurs more frequently in females than males(3:1) but may occur at any age.Most frequently it occurs between the ages of ages of 5 & 10 years developing as a habit tic.In older women it may be a sign of underlying psychiatric disorder.Anxiety & emotional stress are precipitating factors.
Differential Diagnosis
Alopecia areata produces more discrete,completely bald areas of patches.Tinea capitis can produce broken hairs,scaling and inflammation may be present.
Investigations
Hair microscopy will reveal broken hairs of varying lengths.
Management
Occlusion of the area often allows recovery.Children frequently outgrow the habit tic,whilst in adults psychiatric therapy may be required.
BY:
DR CHETAN LALSETA
M.D.(SKIN & V.D.)
CONSULTANT DERMATOLOGIST & COSMETOLOGIST
MIRROR LASER & COSMETIC CENTRE,
SHRADDHA HOSPITAL,
INDIRA CIRCLE CHOWK,
RAJKOT-04
CONTACT NO: 98251 99585
Chetanlalseta@gmail.com
Wednesday, March 4, 2009
DRUG ERUPTIONS
DRUG ERUPTIONS
Drug eruptions are probably the most frequent manifestation of drug sensitivity. Their true incidence is difficult to determine because mild and transitory eruptions are often not recorded and because skin disorders may be falsely attributed to drugs. Certain patient groups are at increased risk of developing an adverse drug reaction. The ampicillin induced rash seen in patients with Infectious mononucleosis is a classical example. Elderly patients and patients with AIDS appear predisposed to adverse drug reactions. Most commonly drugs causing adverse drug reactions are Antimicrobial agents, Antipyretic/ Antiinflammatory analgesics, Antipschycotics & Antihypertensives agents.
1) EXANTHEMATIC( MACULOPAPULAR REACTIONS):
Definition and Clinical features:
The commonest of all cutaneous drug eruptions, occurring in 2-3% of patients, and seen with almost any drug at any time up to 3 weeks after administration.
Typically, there is fine erythematous morbilliform maculopapular eruption of the trunk and extremities that may become confluent. Exanthematic drug reactions often start in areas of trauma or pressure and can be very variable,with either predominantly small papules, or large macules , a reticular eruption , or polycyclic or sheet – like erythema. Intertriginous areas may be favoured, palmar & plantar involvement can occur and face may be spared. Purpuric lesions are common on the legs and erosive stomatitis may develop. Drug exanthema may be accompanied by fever,pruritus and eosinophilia. These eruptions usually fade with desquamation, sometimes with post inflammatory hyperpigmentation.
Drug Associations:
Drugs commonly causing exanthematic reactions include—ampicillin & penicillin,sulfonamides,phenylbutazone,phenytoin,carbamezapine,gentamicin and gold.
2) BULLOUS DRUG ERUPTIONS:
Definition, Clinical features and Drug Associations:
This is a heterogenous group involving many different clinical reactions & mechanisms. Pemphigus and pemphigoid may be drug induced. Penicillamine induced pemphigus is usually of the foliaceus type, while captopril causes a pemphigus vulgaris type eruption. Cicatricial pemphigoid has been described with clonidine and previously with practolol. Fixed eruptions and drug induced vasculitis may have a bullous component, while toxic epidermal necrolysis has widespread blistering. A number of drugs may induce phototoxic bullae. Bullae, often at pressure points, can be present in patients comatose after overdosage with barbiturates, methadone, tricyclic antidepressants and benzodiazepines.
3) URTICARIA:
Definition and clinical features:
Urticaria is the second most common allergic cutaneous reaction to drugs. Allergic urticaria is the cutaneous manifestation of a Type 1( IgE antibody mediated) or Type 3(immune complex mediated) hypersensitivity reaction. Some drugs,e.g. morphine & codeine, can act as direct histamine liberators. Urticaria may accompany serum sickness reactions or systemic anaphylaxis.
Urticaria appears as firm,erythematous,oedematous plaques with normal overlying epidermis and no scaling. Lesions characteristically last for less than 24 hours and are replaced by new lesions in different sites. Giant, papular, arcuate and annular lesions may be seen. Angio-oedema may occur. Pruritus is prominent and bronchospasm,hypotension and eosinophilia may occur. Urticaria usually resolves quickly when the offending drug is withdrawn but,not uncommonly,episodes of urticaria may persist for several weeks after drug discontinuation.
Drug Associations:
Penicillin and salicylates are common provokers. Other commonly implicated agents includes blood products,vaccines,radiocontrast agents,NSAIDS,opiates,cephalosporins & ACE inhibitors.
4) STEVENS-JOHNSON SYNDROME:
Definition and clinical features:
Stevens-Johnson syndrome is a severe variant of erythema multiforme(EM) characterized by widespread involvement of mucosal surfaces.
A prodrome of fever, malaise and prostration is followed by eruption of mucosal bullae, with or without the widespread cutaneous target lesions of EM. Mucosal surfaces, commonly the oral mucosa, respiratory tract and conjunctiva may be extensively involved and secondary infection is common. Morbidity is significant with pain, ocular complications, respiratory compromise,dysuria and difficulty maintaining adequate oral fluid intake.
Drug Associations:
Erythema Multiforme is more commonly precipitated by various infections,but both EM and S J Syndrome can be drug induced. Commonly incriminated are sulfonamides,NSAIDS, barbiturates, phenylbutazone, phenytoin,carbamezapine,phenothiazines,chlorpropamide,thiazide diuretics and malaria prophylaxis.
5) FIXED DRUG ERUPTION:
Definition and clinical features:
A cutaneous reaction that characteristically recurs in the same site(s) each time the drug is administered. Usually just one drug is involved but cross-sensitivity to related drugs may occur. Typical lesions are well demarcated, round or oval,erythematous,dusky plaques with subsequent post inflammatory hyperpigmentation. Bullae are quite common.Lesions arise within 8 hours of drug administration and are common on the extremities, genitalia and perianal areas, Mucous membrane may be involved.
Drug Associations:
A large number of drugs have been reported,but especially tetracyclines,sulphonamides,oxyphenbutazone and fluroquinolones are known to cause fixed drug eruption.
BY:
DR CHETAN LALSETA
M.D.(SKIN & V.D.)
CONSULTANT DERMATOLOGIST & COSMETOLOGIST
MIRROR LASER & COSMETIC CENTRE,
SHRADDHA HOSPITAL,
INDIRA CIRCLE CHOWK,
RAJKOT-04
CONTACT NO: 98251 99585
Chetanlalseta@gmail.com
Drug eruptions are probably the most frequent manifestation of drug sensitivity. Their true incidence is difficult to determine because mild and transitory eruptions are often not recorded and because skin disorders may be falsely attributed to drugs. Certain patient groups are at increased risk of developing an adverse drug reaction. The ampicillin induced rash seen in patients with Infectious mononucleosis is a classical example. Elderly patients and patients with AIDS appear predisposed to adverse drug reactions. Most commonly drugs causing adverse drug reactions are Antimicrobial agents, Antipyretic/ Antiinflammatory analgesics, Antipschycotics & Antihypertensives agents.
1) EXANTHEMATIC( MACULOPAPULAR REACTIONS):
Definition and Clinical features:
The commonest of all cutaneous drug eruptions, occurring in 2-3% of patients, and seen with almost any drug at any time up to 3 weeks after administration.
Typically, there is fine erythematous morbilliform maculopapular eruption of the trunk and extremities that may become confluent. Exanthematic drug reactions often start in areas of trauma or pressure and can be very variable,with either predominantly small papules, or large macules , a reticular eruption , or polycyclic or sheet – like erythema. Intertriginous areas may be favoured, palmar & plantar involvement can occur and face may be spared. Purpuric lesions are common on the legs and erosive stomatitis may develop. Drug exanthema may be accompanied by fever,pruritus and eosinophilia. These eruptions usually fade with desquamation, sometimes with post inflammatory hyperpigmentation.
Drug Associations:
Drugs commonly causing exanthematic reactions include—ampicillin & penicillin,sulfonamides,phenylbutazone,phenytoin,carbamezapine,gentamicin and gold.
2) BULLOUS DRUG ERUPTIONS:
Definition, Clinical features and Drug Associations:
This is a heterogenous group involving many different clinical reactions & mechanisms. Pemphigus and pemphigoid may be drug induced. Penicillamine induced pemphigus is usually of the foliaceus type, while captopril causes a pemphigus vulgaris type eruption. Cicatricial pemphigoid has been described with clonidine and previously with practolol. Fixed eruptions and drug induced vasculitis may have a bullous component, while toxic epidermal necrolysis has widespread blistering. A number of drugs may induce phototoxic bullae. Bullae, often at pressure points, can be present in patients comatose after overdosage with barbiturates, methadone, tricyclic antidepressants and benzodiazepines.
3) URTICARIA:
Definition and clinical features:
Urticaria is the second most common allergic cutaneous reaction to drugs. Allergic urticaria is the cutaneous manifestation of a Type 1( IgE antibody mediated) or Type 3(immune complex mediated) hypersensitivity reaction. Some drugs,e.g. morphine & codeine, can act as direct histamine liberators. Urticaria may accompany serum sickness reactions or systemic anaphylaxis.
Urticaria appears as firm,erythematous,oedematous plaques with normal overlying epidermis and no scaling. Lesions characteristically last for less than 24 hours and are replaced by new lesions in different sites. Giant, papular, arcuate and annular lesions may be seen. Angio-oedema may occur. Pruritus is prominent and bronchospasm,hypotension and eosinophilia may occur. Urticaria usually resolves quickly when the offending drug is withdrawn but,not uncommonly,episodes of urticaria may persist for several weeks after drug discontinuation.
Drug Associations:
Penicillin and salicylates are common provokers. Other commonly implicated agents includes blood products,vaccines,radiocontrast agents,NSAIDS,opiates,cephalosporins & ACE inhibitors.
4) STEVENS-JOHNSON SYNDROME:
Definition and clinical features:
Stevens-Johnson syndrome is a severe variant of erythema multiforme(EM) characterized by widespread involvement of mucosal surfaces.
A prodrome of fever, malaise and prostration is followed by eruption of mucosal bullae, with or without the widespread cutaneous target lesions of EM. Mucosal surfaces, commonly the oral mucosa, respiratory tract and conjunctiva may be extensively involved and secondary infection is common. Morbidity is significant with pain, ocular complications, respiratory compromise,dysuria and difficulty maintaining adequate oral fluid intake.
Drug Associations:
Erythema Multiforme is more commonly precipitated by various infections,but both EM and S J Syndrome can be drug induced. Commonly incriminated are sulfonamides,NSAIDS, barbiturates, phenylbutazone, phenytoin,carbamezapine,phenothiazines,chlorpropamide,thiazide diuretics and malaria prophylaxis.
5) FIXED DRUG ERUPTION:
Definition and clinical features:
A cutaneous reaction that characteristically recurs in the same site(s) each time the drug is administered. Usually just one drug is involved but cross-sensitivity to related drugs may occur. Typical lesions are well demarcated, round or oval,erythematous,dusky plaques with subsequent post inflammatory hyperpigmentation. Bullae are quite common.Lesions arise within 8 hours of drug administration and are common on the extremities, genitalia and perianal areas, Mucous membrane may be involved.
Drug Associations:
A large number of drugs have been reported,but especially tetracyclines,sulphonamides,oxyphenbutazone and fluroquinolones are known to cause fixed drug eruption.
BY:
DR CHETAN LALSETA
M.D.(SKIN & V.D.)
CONSULTANT DERMATOLOGIST & COSMETOLOGIST
MIRROR LASER & COSMETIC CENTRE,
SHRADDHA HOSPITAL,
INDIRA CIRCLE CHOWK,
RAJKOT-04
CONTACT NO: 98251 99585
Chetanlalseta@gmail.com
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