| Skin consists of | 1 Outer Epidermis
2 Inner Epidermis |
| Epidermis parts | 1 stratum basale (basal layer),
2 stratum spinosum (prickle cell layer)
3 stratum granulosum (granular layer)
4 stratum corneum (horny layer) |
| 1 provide resilience to mechanical stress
2 provide color and protect from UV penetration
3 consist of sweat, oils, corneocytes, protein
decomposition products, and transepidermal water
4 a much thicker layer that contains nerve endings and blood vessels | 1 Keratinocytes
2 Melanocytes
3 Hydrolipid film
4 dermis |
| 1 contains more water and is thinner for enhanced
topical drug absorption
2 tends to be drier, thinner, and more friable (external
insults)
3 Exposure to __ accelerates
aging and skin cancer | 1 Pediatric skin
2 Aged skin
3 radiation |
| PATHOPHYSIOLOGY:
1 Localized DRUG-INDUCED REACTIONS
2 Allergic DRUG-INDUCED REACTIONS
Depend on inducing an immune response from the host
Classified as: | 1 Chemical vaginitis (vaginal douches, spermicides,
and imidazoles)
2
Blistering
Exanthematous
Pustular eruptions
Urticarial |
| Afebrile exanthematous eruption
most commonly encountered.
S/S: Erythematous macules and
papules that may be pruritic. Lesions
usually begin within 7-10 days after
offending medication
Resolution: 7-14 days | Maculopapular skin reaction |
| aka drug reaction with eosinophilia
an exanthematous eruption
accompanied by fever, lymphadenopathy, and multiorgan involvement
S/S: begin 1–4 weeks after starting the
offending drug | Drug hypersensitivity syndrome (DRESS) |
| S/S: hives, extremely pruritic red raised
wheals, angioedema, and mucous
membrane swelling that typically occurs
within minutes to hours | Urticaria and angioedema |
| complex urticarial eruptions
S/S: fever, rash (usually urticarial),
and arthralgias, usually within 1–3
weeks after starting the offending
drug. | Serum sickness-like reactions |
| Immune complex or cell-mediated allergic
responses
S/S: generalized tender/painful bullous
formation with fever, headache, and
respiratory symptoms, that rapidly
deteriorate. | Stevens-Johnson Syndrome and Toxic
Epidermal Necrolysis (SJS/TEN) |
| simple pustular eruptions caused by
medications that induce acne
(whiteheads or blackheads).
onset is usually about one to three
weeks. | Acneiform drug reactions |
| complex pustular eruption
S/S: acute onset (within days after
starting the offending drug), fever,
diffuse erythema, and many pustules. | Acute generalized exanthematous pustulosis (AGEP) |
| may be related to increased melanin
hydantoins
direct deposition
- silver, mercury, tetracyclines,
antimalarials
other mechanisms (some cytotoxic
drugs) | Hyperpigmentation |
| may be phototoxic or photoallergic.
Drugs that induce phototoxic reactions absorb ultraviolet A (UVA) light | Photosensitivity |
| COMMON SKIN DISORDER | 1 CONTACT DERMATITIS
2 DIAPER DERMATITIS
3 SKIN CANCER |
| Skin inflammation caused by irritants or allergic sensitizers
Eczematous inflammation, with erythema, vesicles, papules, crusting, fissuring, or scaling | CONTACT DERMATITIS |
| 1 contact dermatitis that occur several days later,
immunologic response
2 contact dermatitis that occur few hours, organic
substance | 1 Allergic CD
2 Irritant CD |
| Acute, inflammatory dermatitis of the buttocks, genitalia, and perineal region
Direct fecal and moisture contact with the skin
Erythematous, and severe rashes may have vesicles or oozing erosions | DIAPER DERMATITIS / Diaper rash |
| 1 causes red plaques, papules, and pustules in diaper rash | 1 Candida species |
| DRUG-INDUCED REACTIONS MANAGEMENT
Management & Treatment
1 IF severe case:
2 IF w/ fever:
3 IF SJS/TEN: | Termination of suspected drug
1 IF severe case:
-- Corticosteroids
2 IF w/ fever:
-- Acetaminophen
3 Broad spectrum antibiotics &
vancomycin, IVIG |
| CONTACT DERMATITIS MANAGEMENT
1) 1st goal:
2) 2nd goal: | .
1 identify, withdraw, avoid offending agent using
Patch Test -> gold standard
2 provide symptomatic relief while
decreasing skin lesions.
-> cold compresses
-> topical corticosteroids |
| DIAPER DERMATITIS MANAGEMENT
1 Non pharmacologic
2 Drugs
3 DOC for candidal rash: | 1) Frequent diaper changes
Air drying
Gentle cleansing
2)
Zinc oxide (astringent)
Petrolatum (moisture)
3 imidazole |
| SKIN CANCER MANAGEMENT
1 Squamous Cell Carcinoma (SCC) treatment
2 Basal Cell Carcinoma (BCC)
3 Malignant melanoma
- give also drug for metastatic melanoma | .
1 surgical excision
2 may involve surgical excision;
topical agents (imiquimod or antineoplastic agents,
such as 5-fluorouracil)
3 antineoplastic therapy, (temozolomide) or
(dacarbazine for metastatic melanoma) |
