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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 16, Dermatologic Drug Reactions and Common Skin Conditions.

KEY CONCEPTS

KEY CONCEPTS

  • imagePatients presenting with a skin condition should be interviewed thoroughly regarding signs and symptoms, urgency, other subjective complaints, and medication history. The skin eruption should be carefully assessed to help distinguish between a disease condition and a drug-induced skin reaction.

  • imageDrug-induced skin reactions may be caused by systemic or topical medications and can be irritant (if topical route) or allergic (topical or systemic route) in nature.

  • imageAllergic drug reactions can be classified into exanthematous, urticarial, blistering, and pustular eruptions. Exanthematous reactions include maculopapular rashes and drug hypersensitivity syndrome. Urticarial reactions include urticaria, angioedema, and serum sickness-like reactions. Blistering reactions include fixed drug eruptions, Stevens-Johnson syndrome, and toxic epidermal necrolysis (SJS/TEN). Pustular eruptions include acneiform drug reactions and acute generalized exanthematous pustulosis. Other drug-induced skin reactions include hyperpigmentation and photosensitivity.

  • imageNot all skin reactions are drug induced. In clinical practice, a diagnosis of drug-induced skin reaction is often a diagnosis of exclusion (ie, the diagnosis is reached after other possible diagnoses have been ruled out).

  • imageContact dermatitis is a common skin disorder caused either by an irritant contactant or an allergic/sensitizing contactant, resulting in an irritant contact dermatitis (ICD) or an allergic contact dermatitis (ACD).

  • imageAn ICD is confined to the area of chemical contact whereas an ACD may extend beyond the areas of contact. However, it may sometimes be difficult to differentiate an ICD from an ACD.

  • imagePatch testing is a criterion standard for the diagnosis of ACD—the crucial investigative and diagnostic method used together with a detailed clinical history and physical exam/workup.

  • imageThe first goals of therapy in the management of contact dermatitis involve identification, withdrawal, and avoidance of the offending agent. A thorough history, including occupational history, must be carefully reviewed for potential contactants.

  • imageOther goals of therapy for contact dermatitis include providing symptomatic relief, implementing preventive measures, and providing coping strategies and other information for patients and caregivers.

  • imagePhotoaging is premature skin aging most commonly due to sun exposure.

  • imageSkin cancers include squamous cell carcinoma, basal cell carcinoma, and malignant melanoma.

PATIENT CARE PROCESS

Patient Care Process

Two Patient Cases appear later in this chapter to enhance learning, as follows:

  1. Patient case 1 – Dermatologic drug reaction

  2. Patient case 2 – Contact dermatitis

PRECLASS ACTIVITY

Preclass Engaged Learning Activity

Review Chapter e16 – Skin Care and Minor/Self-Treatable Dermatologic Conditions in this textbook, Pharmacotherapy: A Pathophysiologic Approach, 11th ed., for background on skin structure and function, transdermal drug absorption, and definitions of macules, papules, nodules, and nevi.

INTRODUCTION

As the fictional character Lois Lane said, “… the light always returns to show us things ...

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