Sandbox 09232014

Cutaneous reactions	Clnical features	Implicated medications
Exanthems	Delayed-type hypersensitivity Evolve over days after drug initiation Diffuse macules and papules	Allopurinol, amphotericin, barbiturates, captopril, carbamazepine, cephalosporins, chloramphenicol, erythromycin, furosemide, gentamicin, gold salts, lithium, nalidixic acid, nitrofurantoin, penicillins, phenothiazines, phenylbutazone, phenytoin, sulfonamides), thiazides
Urticaria/ angioedema	Often IgE mediated Onset within minutes of drug initiation	ACE inhibitors, aminosalicylic acid, anticonvulsants, aspirin, atropine, cephalosporins, dextran, hydralazine, monoclonal antibodies, NSAIDs, opioids, penicillins, pentamidine, quinine, sulfonamides, tetracyclines, thiouracil, tubocurarine, vancomycin
Fixed drug eruption	Hyperpigmented plaques that recur at same skin or mucosal site	ACE inhibitors, allopurinol, amlodipine, aspirin, barbiturates, benzodiazepines, carbamazepine, cephalosporins, clindamycin, co-trimoxazole, dextromethorphan, diltiazem, fluconazole, lamotrigine, lansoprazole, metronidazole, NSAIDs, paclitaxel, paracetamol, penicillin, phenolphthaleinomeprazole, quinine, salicylates, sulfonamides, terbinafine, tetracyclines, trimethoprim
Pustules	Acute generalized eczematous pustulosis (AGEP) Acneiform	AGEP: antibiotics, calcium-channel blockers Acneiform: corticosteroids, sirolimus
Bullous	Flaccid blisters Tense blisters	Flaccid blisters: captopril, penicillamine Tense blisters: furosemide, vancomycin
Cutaneous lupus erythematosus	Erythematous/scaly plaques in photodistribution	Hydrochlorothiazide, calcium-channel blockers, ACEIs
Stevens-Johnson syndrome (SJS)	Purpuric macules on face and trunk with <10% epidermal detachment, fever, stomatitis, ocular involvement	antibiotics, barbiturates, β-lactam antibiotics, carbamazepine, chlorpropamide, co-trimoxazole, gold, H2 blocker, histamine, lamotrigine, leflunomide, macrolides, mefloquine, NSAIDs, phenothiazines, phenytoin, rifampicin, sulfonamides, tetracyclines, thiazides
Toxic epidermal necrolysis (TEN)	Similar to SJS but >30% epidermal detachment	Allopurinol, barbiturates, carbamazepine, gold, griseofulvin, lamotrigine, leflunomide, nitrofurantoin, NSAIDs, penicillins, phenytoin, salicylates, sulfonamides, tetracyclines

Organ-specific reactions	Clnical features	Implicated medications
Pulmonary	Pulmonary fibrosis, hypersensitivity pneumonitis	Nitrofurantoin, bleomycin, methotrexate
Hepatic	Hepatitis, cholestasis	Para-aminosalicylic acid, sulfonamides, phenothiazines
Renal	Interstitial nephritis, membranous glomerulonephritis	Penicillin, sulfonamides, gold, penicillamine, allopurinol
Hematologic	Hemolytic anemia, thrombocytopenia, granulocytopenia	Penicillin, quinine, sulfonamides

Multiorgan reactions	Clnical features	Implicated medications
Anaphylaxis	Urticaria, angioedema, bronchospasm, gastrointestinal symptoms, hypotension	β-lactam antibiotics, monoclonal antibodies
Systemic lupus erythematosus	Arthralgia, myalgias, fever, malaise	Hydralazine, procainamide, isoniazid
Vasculitis	Cutaneous or visceral vasculitis	Allopurinol, aspirin, β-lactam antibiotics, carbamazepine, carbimazole, co-trimoxazole, diltiazem, erythromycin, furosemide, gold, G-CSF, GM-CSF, hydralazine, interferons, methotrexate, minocycline, NSAIDs, penicillamine, propylthiouracil, retinoids, sulfasalazine, sulfonamides, thiazides, thrombolytics
Serum sickness	Urticaria, arthralgia, fever	Heterologous antibodies, infliximab
Drug reaction with eosinophilia and systemic symptoms (DRESS)	Cutaneous eruption, fever, eosinophilia, hepatic dysfunction, lymphadenopathy	Anticonvulsants, sulfonamides, minocycline, allopurinol