Quiz
Cutaneous adverse reactions – 10 cases

Cutaneous adverse reactions to medications are common; many are non-immunological in nature. This quiz considers some drug eruptions believed to be immunologically-mediated ('drug allergy'), or that are at least idiosyncratic in nature.
Often it is difficult to be certain whether a rash is due to drug, a skin disease or an underlying illness. A careful drug history is essential, considering prescription and over-the-counter medicines, topical agents, herbal remedies and supplements. Previous exposure, dose, duration and frequency of drug administration should be established. Refer to standard textbooks and obtain specialist advice from a dermatologist as necessary.

For each of the ten cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.

Each case should take approximately 2 minutes to complete. There is a list of suggested further reading material at the end of the quiz.

When you finish the quiz, you can download a certificate.

Case 9

Name this skin condition.

Bullous drug eruption

What are its clinical features?

This patient presented with erythroderma, which soon progressed to a generalised bullous eruption. It was associated with fever, marked eosinophilia, mild renal and hepatic impairment. The combination of clinical features is typical of drug hypersensivity syndrome, although bullae are uncommon. An ACE inhibitor was the likely culprit in this case.

List drugs that are commonly responsible.

The most common drugs to cause this reaction are the anti-gout drug, allopurinol, a number of anti-epilepsy drugs (particularly carbamazepine, phenobarbital and phenytoin) and the sulphonamide group of antibiotics.

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