DIAGNOSIS AND MANAGEMENT

EXANTHEMATOUS DRUG ERUPTION

ACHMAD DAMANHURI
110 210 0081
SEPTIAWATI SALEH 110 210 0011
IKA ALFIA JULIATY 110 208 0110
ADVISOR :

dr. Nur Rachma Jumiaty

SUPERVISOR:
dr. Asnawi Madjid, Sp.KK, MARS

DEFINITION
Exanthematous eruption
morbiliform or maculopapular
most common form of drug eruption,
accounting for approximately 95% of
skin reactions.

ETIOLOGY
Exanthematous can be caused by
many drugs
antimicrobial (penicillins,
sulfonamid, cephalosporins)
NSAID
anti convulsant (benzodiazepin,
carbamazepine)
allopurinol

EPIDEMIOLOGY
Any age. Elderly patients have an
increased prevalence of adverse drug
reactions
more prevalent in women than in
men.
Severe and potentially lifethreatening eruptions occur in
approximately 1 in 1000 hospital
patients.

PATHOGENESIS
A drug reaction mechanisms are not
understood immunologic reaction type.
nonimmunologic effects. May be immune
mediated.
The major underlying probably
immunological type IV delayed cellmediated hypersensitivity reaction.

Clinical Manifestation
Erythematous macules and papules
that usually presents 7-14 days after
initial exposure to the offending drug.
Distribution : trunk, and spreading
centrifugally face, extremities,
intertriginous, palms, and soles.
Fever and pruritus may occur.

Erythematous macule with papule on

the chest

Erythematous macule with papule spread

simetrically, confluen on the trunk, discret
on extremities

Diagnosis
History taking :
1. History of medication before the eruption
2. The lesion that appear after the medication
3. Another symptom : pruritus and fever
. Physical examination:
1. Distribution : spread centrifugally,
symmetrical
2. Efflorescence : macule erythematous, papule

Supporting Examination
Skin biopsy : can clarify the type of
skin reaction and the mechanism.
But it cant identify the causative
agent.

Focal dermatitis, infiltrate lymphosit and eosinophil

perivascular

DIFERENTIAL DIAGNOSE
ERYTHRODERMA

SECONDARY SYPHILIS

DIFERENTIAL DIAGNOSE
PITYRIASIS
ROSEA

ALLERGIC CONTACT
DERMATITIS

EXANTHEM
ATOUS
DRUG
ERUPTION

ERYTHRODER
MA

SECONDARY
SYPHILIS

PITYRIASIS
ROSEA

ALLERGIC
CONTACT
DERMATITIS

Erythematou
s macule
general with
papule
spread
simetrically,
confluen

Erythematous
macule
universal
(90%-100%),
thin skuama at
healing stage,

Erythematous
papula,
roseola(Eryth
ematous
macule ),
general,
simetrically

Erythematous
papula,
herald patch,
thin skuama,
solitar and
anular.

Erythematous
macule,
udem, papulo
vesicel,

Trunk,
extremities,
intertriginou
s

All over the

body

Trunk,
genitalia

Trunkcosta
area

Hand, trunk,
foot, face,
genitalia

Fever, itch

Fever, itch

Lymfadenitis,
no itch

Itch, no fever

Itch

TREATMENT
Pharmacotherapy (systemic
medication)
Prednisone (1 tab = 5 mg), dosage 1
- 2 mg/kg/day. Adult : 3 x 10 mg/day
Sedating antihistamines
hydroxyzine may provide
symptomatic relief from pruritus.
Dosage : 2 x 10 mg/day, as long as 7
days

TREATMENT
Pharmacotherapy (topical
medication)
Salicil powder 2% + antipruritus
(menthol - 1%)
Topical corticosteroids (krim
hidrocortisol 1% or 2 %)

EDUCATION
Doctor should educate patient to avoid drugs
that have caused drug eruption
Patient have to stop the medication. Therefore
physicians should advise patients to
understand their allergy.
Patients and families were told to make a small
note in the pocket of drug allergy suffered
Inform that patients can be cured in the
presence of hyperpigmentation on the location
of the lesion

PROGNOSIS
Prognosis is Bonam. The eruption will
be cured if the drug of cause is
known and immediately stopped

THANK YOU