Reaction to morbilliform medications

What is it morbilliform reaction to drugs?

Morbilliform drug eruption it is the most common form of drug rash. Many drugs can trigger this allergic reaction, but antibiotics are the most common group. The rash may resemble rashes caused by viruses and bacterial infections

• Morbilliform skin eruption in an adult it is usually due to a drug.
• In a child, it is more likely to be viral in origin.

Morbilliform drug eruption is also called maculopapular drug rash, exanthematous drug and maculopapular rash exanthema.

Who gets morbilliform drug rash?

Around 2% of new drug prescriptions cause a drug rash. About 95% of these are morbilliform drugs. rashes.

They mainly affect people receiving beta-lactam antibiotics (penicillins, cephalosporins), sulfonamides, allopurinol, antiepileptic drugs, and non-steroidal antiepileptic drugs.inflammatory drugs (NSAID) Many other drugs have been reported to cause morbilliform drug eruptions, including herbal and natural therapies.

Predisposing factors include:

• Previous drug eruption or a strong family history of drug eruptions.
• Underlying Viral infectionparticularly acute Epstein Barr virus (EBV, infectious mononucleosis) and human herpesvirus 6 and 7 (see also roseola, pityriasis rosea)

• Immunodeficiency, including human immunodeficiency virus (HIV), cystic fibrosis, autoimmune disorders

• Multiple medications

What Causes Morbilliform Drug Rash?

Morbilliform drug eruption is a form of allergic reaction. It is mediated by cytotoxic T cells and classified as a type IV immune reaction. The target of the attack may be a drug, a metabolite of the drug, or a protein bound to the drug. Inflammation follow the launch of cytokines and another effector immune cells.

What are the clinical features of morbilliform drug eruption?

In the first instance, a morbilliform rash usually appears 1 to 2 weeks after starting the drug, but can occur up to 1 week after stopping it. On re-exposure to the offending (or related) drug, skin lesions appear within 1 to 3 days. It is very rare for a drug that has been taken for months or years to cause a morbilliform drug eruption.

The morbilliform drug eruption usually appears first on the trunk and then spreads to the extremities and neck. the distribution it is bilateral and symmetrical.

the primary injury it's a pink to red floor taint or papule.

• Cancel, targettoid, urticaria-like or polymorphous morphology it can happen.
• Injuries mostly whiten with pressure but may not be bleachable (purple) on the lower legs.
• Discreet lesions may fuse to form large erythematous patches or plates.
• Armpit, groin, hands and feet are generally spared.
• Paradoxical eruption prominent in armpits and the English may be due to symmetrical drugs related intertriginous and flexural rash (SDRIFE)
• Mucous membranes hair and nail they are not affected in uncomplicated drug eruptions.

The rash may be associated with a mild fever and itching As it improves, the redness disappears and the superficial skin peels off.

What are the complications of morbilliform drug eruption?

In the initial phase, it may not be possible to clinically distinguish an uncomplicated morbilliform rash from a more severe one cutaneous Adverse reactions (SCAR). These are:

• Drug hypersensitivity syndrome

• Stevens Johnson syndrome - toxic epidermal necrolysis (SJS / TEN)

• Acute generalized exanthematous pustulosis (AGEP)

Patients with the following symptoms / signs should be hospitalized for specialized evaluation and supportive care.

• Erythroderma (participation of the whole body)
• High or significant fever discomfort
• None mucous membrane intervention
• Skin tenderness
• Burning
• Pustules
• Palpable purple
• Evidence of other organ involvement (eg, liver, kidneys, lungs, blood)

How is morbilliform drug eruption diagnosed?

A strong clinical suspicion of morbilliform drug eruption depends on:

• Typical exanthematic rash
• Recently introduced drug

To identify the possible causal drugA medication calendar, which includes all prescription and over-the-counter products, can be helpful. The start date of each new medication is documented along with the onset of the rash. The calendar must extend at least 2 weeks and up to a month. Medications can be classified as unlikely or probable causes based on:

• Time relative to onset of eruption
• The specific drug; some drugs can be excluded because they rarely cause allergy
• Past patient experience with other drugs in the same class

There are no routine tests to make the diagnosis or identify the culprit drug. Differential diagnosis includes measles, rubella, scarlet fever, non-specific toxic erythema associated with infection, Kawasaki disease, connective tissue disease and acute graft versushost disease.

Tests are generally not necessary if the cause has been identified and stopped, the rash is mild, and the patient is fine. They may include:

• Routine blood count, liver and kidney function tests, C-reactive protein
• Serology for infections that can cause similar rashes
• Possible skin biopsy, which shows the interface dermatitis, mixed perivascular infiltration and another histopathological features.

Eosinophilia It is supportive but not diagnostic. Further investigations will depend on the clinical features, the patient's progress, and the results of the initial tests.

What is the treatment for morbilliform drug eruption?

The most important thing is to identify the offending drug and, if possible, stop it. If the reaction is mild and the drug is essential and not replaceable, get a specialist's opinion if it is safe to continue the drug before doing so.

• Monitor the patient carefully for complications.
• Apply emollients and powerful current steroid creams.
• Consider wet wraps for very red and inflamed skin.

• Antihistamines are often prescribed, but generally not very helpful.

How can morbilliform drug eruption be prevented?

Morbilliform eruptions cannot be completely prevented. Prescribers must be vigilant. its incidence can be reduced by:

• Minimize prescriptions for antibiotics.
• Educate the patient about the cause of their rash and the danger of a new exposure to the same drug.
• Add reaction to medical record alerts

What is the prognosis for morbilliform drug eruption?

If the offending drug is stopped, the rash begins to improve in 48 hours and disappears in 1 to 2 weeks.

If the medication continues, the rash may:

• Resolve despite continued drug exposure
• Persist without change
• Progress to erythroderma