Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Side Effects May Include: Illustrative Cases of Dermatologic Adverse Reactions
Description
The presentation focuses on severe dermatologic adverse reactions associated with medications, detailing two case studies highlighting the complexities of drug reactions like Toxic Epidermal Necrolysis (TEN) and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). The first case involves a 27-year-old woman who developed a severe rash and mucositis after being prescribed lamotrigine for OCD, leading to significant dermal damage and requiring hospitalization. Risk factors for lamotrigine linked SJS/TEN include high starting doses and rapid titration. The second case features a 26-year-old woman who experienced delayed DRESS symptoms following amoxicillin use, compounded by repeated low-steroid treatment that failed to adequately control her symptoms. The presentation emphasizes the importance of recognizing prodromal symptoms, appropriate dosing, the risk of secondary infections, and the coordination of care across specialties. It also underscores the necessity for patient follow-ups post-discharge, as many suffer from psychological repercussions, including PTSD and medication fears. Both cases illustrate a need for better awareness of medication risks, careful management strategies, and potential genetic testing to mitigate adverse reactions.
View moreConclusions
- Lamotrigine is associated with a notable risk of severe drug reactions, including Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), particularly when used at a high starting dose or with multiple co-medications.
- The incidence of SJS/TEN linked to lamotrigine is higher than with other commonly known triggers, indicating the need for cautious prescribing practices.
- Early identification and immediate cessation of any suspect medications is critical in the management of SJS/TEN.
- Patients exhibiting early signs of rash should be carefully monitored, and genetic screening may help mitigate risks associated with lamotrigine.
- Appropriate management in specialized units (like burn units or ICUs) and the involvement of multidisciplinary teams are essential for the treatment of severe reactions.
- Supportive care should be prioritized, with systemic corticosteroids reserved for cases with significant involvement of lungs or kidneys.
- Long-term follow-up care is vital as patients may experience psychological sequelae such as anxiety and depression after surviving severe drug reactions.
- Avoiding rapid tapering of corticosteroids is important to prevent relapses in DRESS syndrome patients.
- An Bras Dermatol. 2017 Jan-Feb; 92(1): 139-141
- British Journal of Dermatology (2015) 173, pp1250-1254
- Ophthalmology Volume 123, Number 3, March 2016
- Niemeijer, IC, et al. Archives of Gynecology and Obstetrics. 2009; 280:851-854.
- Meneux E, et al. Obstetrics and Gynecology. 1998; 91:283-287.
- JAMA Dermatology. 2021:157(6):712-715.
- JAMA Dermatology December 2022 Volume 158, Number 12
- Clin Invest 2018; 128:1985
- J Allery Clin Immunol Pract
- J Am Acad Dermatol 2022;86:1236-45