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Systemic dermatology

Drug eruption diagnostic challenge

Antibiotics

Match each picture with the correct diagnosis:

Mix and match: [table] : Cefaclor || Five percent of courses of cefaclor result in a serum sickness reaction in children ie the urticaria is accompanied by arthralgia and fever. : Minocycline || Bluish pigmentation is an occasional adverse reaction to long term minocycline, particularly in those over 50. Internal organs such as thyroid may also be affected. : Cotrimoxasole || Up to 30% of fixed drug eruptions are due to co-trimoxasole, but other antibiotics including penicillins and tetracyclines may be responsible. : Ampicillin || Toxic erythema complicates 5-8% of courses of ampicillin and is less often due to other antibiotics. The rash usually clears within a few days.

Miscellaneous

Mix and match: [table] : Azathioprine || Longterm use of immunosuppressive drugs in fair skinned sun-exposed New Zealanders inevitably leads to multiple skin cancers. : Prednisone || This patient developed striae in unusual sites including calves and lower back. She had received multiple courses of oral prednisone for asthma in childhood. : Lithium || Lithium appears to provoke or aggravate psoriasis in those predisposed to it. The mechanism is unknown. Other drugs that may aggravate psoriasis include beta blockers and antimalarials. : Naproxen || Therapeutic agents from virtually every pharmacological class have been implicated in the development of drug-induced hypersensitivity vasculitis but antibiotics and nonsteroidal anti-inflammatory agents are the most common.

Dermatological treatments

Mix and match: [table] : Clobetasol propionate cream || Ultrapotent topical steroid causing atrophy, purpura and tinea incognito : 5-Fluorouracil cream || Cytotoxic causing erosion and crusting of solar keratoses : Oral methotrexate || Stomatitis probably related to folic acid deficiency induced by folate antagonist : Oral isotretinoin || Retinoid resulting in cheilitis and dry skin