These reactions are characterized by one or more sharply demarcated, erythematous lesions, sometimes leading to a blister. Hyperpigmentation results after resolution of the acute inflammation. With rechallenge, the lesion recurs in the same (., fixed) location. Lesions often involve the lips, hands, legs, face, genitalia, and oral mucosa and cause a burning sensation. Most patients have multiple lesions. Fixed drug eruptions have been associated with phenolphthalein, sulfonamides, cyclines, dipyrone, NSAIDs, and barbiturates. Patch testing has been used in Europe to help establish the etiology. Immune Cutaneous Reactions: Severe VASCULITIS Cutaneous necrotizing vasculitis often presents as palpable purpuric lesions that may be. | Chapter 056. Cutaneous Drug Reactions Part 7 FIXED DRUG ERUPTIONS These reactions are characterized by one or more sharply demarcated erythematous lesions sometimes leading to a blister. Hyperpigmentation results after resolution of the acute inflammation. With rechallenge the lesion recurs in the same . fixed location. Lesions often involve the lips hands legs face genitalia and oral mucosa and cause a burning sensation. Most patients have multiple lesions. Fixed drug eruptions have been associated with phenolphthalein sulfonamides cyclines dipyrone NSAIDs and barbiturates. Patch testing has been used in Europe to help establish the etiology. Immune Cutaneous Reactions Severe VASCULITIS Cutaneous necrotizing vasculitis often presents as palpable purpuric lesions that may be generalized or limited to the lower extremities or other dependent areas Chap. 319 . Urticarial lesions ulcers and hemorrhagic blisters also occur. Vasculitis may involve other organs including the liver kidney brain and joints. Drugs are an infrequent cause of vasculitis. Infection and collagen vascular disease are responsible for the majority of cases. Propylthiouracil induces a cutaneous vasculitis that is accompanied by leukopenia and splenomegaly. Direct immunofluorescent changes in these lesions suggest immune-complex deposition. Drugs implicated in vasculitis include allopurinol thiazides sulfonamides other antimicrobials and several NSAIDs. The presence of eosinophils in the perivascular infiltrate of skin biopsy may indicate a higher probability of a drug etiology. PUSTULAR ERUPTIONS AGEP is a rare reaction pattern often associated with exposure to drugs. Usually beginning on the face or intertriginous areas small nonfollicular pustules overlying erythematous and edematous skin may coalesce and lead to superficial ulceration. Differentiating this eruption from TEN in its initial stages may be difficult. A skin biopsy is important and shows scattered pustules in the upper part of the
