Drug eruptions — Clinical Case (Wikimedia Commons)

Diagnosis: Drug eruptions

Steroid thinned skin. L=Prior to Clobetasol, M=During Clobetasol treatment; R=After discontinuing Clobetasol. Clinical photograph sourced from Wikimedia Commons (CC BY-SA 4.0). Attribution: Corinna Kennedy.

Clinical Presentation

Morbilliform: symmetric erythematous macules/papules, often trunk first. Urticarial: wheals. Fixed drug eruption: well-demarcated violaceous plaques recurring at same site. SJS/TEN: targetoid lesions, mucosal erosions, epidermal detachment.

Clinical History

Detailed medication history with timeline is critical. New medications within 1-3 weeks for morbilliform, 4-8 weeks for DRESS. Previous drug reactions. Consider OTC medications, supplements, and recent contrast agents.

Treatment

Discontinue offending agent. Mild: topical corticosteroids, antihistamines. SJS/TEN: ICU care, wound management, consider IVIG or cyclosporine. DRESS: systemic corticosteroids with slow taper.

Differential Diagnosis

Viral exanthem, Morbilliform drug eruption, DRESS syndrome, SJS/TEN, Fixed drug eruption, AGEP

Key Learnings

DRESS has a longer latency (2-8 weeks) and involves internal organ dysfunction. SCORTEN predicts mortality in SJS/TEN. Always document drug allergies and consider cross-reactivity patterns.

Tags: drug eruption, adverse drug reaction, morbilliform, medication