Lecture Notes Dermatology - Graham-Brown, Robin, Burns, Tony

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174 Skin and the psyche Pathological skin picking ‘ Neurotic excoriations ’ is a term for a disorder, encountered predominantly in middle - aged women, in which skin lesions are produced by picking and gouging, and are usually scattered over the arms, upper trunk and face. More recent lesions are usually interspersed with scars from previous excoriations. Acne excori é e is a variant of this condition in which minimal acne lesions are repeatedly picked and gouged, leaving scars when the lesions heal. Patients with these problems have obsessive – compulsive personalities, and picking the skin appears to provide relief of unconscious aggression and tension. Antidepressants and supportive psychotherapy may be of benefit.
21 Cutaneous d rug r eactions There are only two types of drug — those that don ’ t work and those that have side - effects. Bruno Handel frcs to a specific drug is difficult, and judgements usually have to be made on clinical grounds alone. Introduction The skin is one of the most common sites for unwanted drug effects (a better term than ‘ side effects ’ ), although estimates of the frequency vary considerably. Cutaneous drug reactions are probably under - reported and certainly often go unrecognized. Note, however, that skin disorders wholly unrelated to drug ingestion can be labelled erroneously. It is important not to jump to conclusions: we have seen viral infections and scabies diagnosed as drug reactions. There are many people who state that they are ‘ allergic to penicillin ’ , but who are not. Cutaneous drug reactions may be due to several different mechanisms. Unfortunately there are no reliable in vitro tests for establishing that a rash is due to a drug. Simple in vivo tests, such as prick testing and patch testing, have a limited place in specific situations, but usually yield no useful information either. However, even if the mechanism(s) for a particular reaction is known (and it often isn ’ t), a test may not be appropriate because the reaction is not to the drug itself, but to a drug complex or metabolite that is produced in vivo after ingestion or administration. The only definitive test is direct challenge with the suspected agent, but this may be impossible or unethical in many circumstances. For these reasons, proving that a specific eruption was due Lecture Notes: Dermatology, 10th edition. © RAC Graham-Brown and DA Burns. Published 2011 by Blackwell Publishing Ltd. Causes of drug reactions • Simple intolerance • Hypersensitivity: types I, II, III and IV • Pharmacokinetic disturbances • Drug interactions • Complex interactions between host, drug and environment (e.g. light) Drug r eaction p atterns However, all is not lost! Some drugs are much more prone to induce cutaneous drug reaction patterns than others. Common offenders include those in the box. Drugs causing skin reactions • Antibiotics (especially penicillin, semisynthetic penicillins and sulfonamides) • Non - steroidal anti - infl ammatory drugs • Hypnotics • Tranquillizers Furthermore, there are a number of well - defined clinical drug reaction patterns. Some of these patterns are more specific to certain drugs, and this may help to identify the culprit.
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Lecture Notes: Dermatology
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This edition first published 2011,
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Contributor Chapter 23: Dermatologi
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Acknowledgements We are indebted to
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2 Structure and function of the ski
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10 Approach to the diagnosis of der
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20 Bacterial and viral infections o
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22 Bacterial and viral infections E
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24 Bacterial and viral infections P
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26 Bacterial and viral infections F
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28 Bacterial and viral infections F
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30 Fungal infections 4 Fungal i nfe
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32 Fungal infections Figure 4.3 Tin
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34 Fungal infections Figure 4.7 Sca
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36 Fungal infections Candida i nfec
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38 Fungal infections this gives a c
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40 Ectoparasite infections 5 Ectopa
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42 Ectoparasite infections Figure 5
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44 Ectoparasite infections applicat
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46 Ectoparasite infections Pediculi
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48 Ectoparasite infections Figure 5
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50 Ectoparasite infections Animal m
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52 Acne, acneiform eruptions and ro
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60 7 Eczema Eczema The terms ‘ecz
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62 Eczema Figure 7.3 Hand dermatiti
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64 Eczema Occupational c ontact d e
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66 Eczema widespread skin lesions (
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68 Eczema Figure 7.8 Eczema craquel
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70 Psoriasis Parakeratosis Polymorp
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72 Psoriasis Figure 8.5 Psoriatic o
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74 Psoriasis Figure 8.9 Acute pustu
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76 Psoriasis Vitamin D a nalogues a
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78 Psoriasis between psoriatic arth
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80 Benign and malignant skin tumour
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96 Naevi Table 10.1 A classificatio
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98 Naevi (a) (b) (c) Figure 10.3 Th
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100 Naevi Figure 10.7 Deep capillar
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102 11 Inherited disorders Inherite
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104 Inherited disorders Figure 11.2
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106 Inherited disorders Peutz - Jeg
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108 Inherited disorders which MRP6
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110 12 Pigmentary disorders Pigment
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112 Pigmentary disorders Figure 12.
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114 Pigmentary disorders Hyperpigme
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116 Disorders of the hair and nails
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Page 134 and 135: 124 Bullous disorders Physical c au
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Page 138 and 139: 128 Bullous disorders The main path
Page 140 and 141: 130 Miscellaneous disorders, and li
Page 152 and 153: 142 16 Vascular disorders Vascular
Page 154 and 155: 144 Vascular disorders Figure 16.3
Page 156 and 157: 146 Vascular disorders Figure 16.4
Page 158 and 159: 148 Vascular disorders rather unimp
Page 160 and 161: 150 Connective tissue diseases Figu
Page 162 and 163: 152 Connective tissue diseases Figu
Page 164 and 165: 154 Connective tissue diseases Fron
Page 166 and 167: 156 Connective tissue diseases Nerv
Page 168 and 169: 158 Pruritus But watch out! Subtle
Page 170 and 171: 160 Pruritus Systemic disorders cau
Page 172 and 173: 162 Systemic disease and the skin 1
Page 174 and 175: 164 Systemic disease and the skin F
Page 180 and 181: 170 20 Skin and the psyche Skin and
Page 182 and 183: 172 Skin and the psyche expertise i
Page 186 and 187: 176 Cutaneous drug reactions Common
Page 188 and 189: 178 Cutaneous drug reactions Figure
Page 190 and 191: 180 Cutaneous drug reactions Exacer
Page 192 and 193: 182 Treatment of skin disease cosme
Page 194 and 195: 184 Treatment of skin disease arm,
Page 196 and 197: 186 Treatment of skin disease Vitam
Page 198 and 199: 188 23 Dermatological emergencies E
Page 200 and 201: 190 Dermatological emergencies mala
Page 202 and 203: 192 Case study questions Figure C1.
Page 204 and 205: 194 Case study questions Case s tud
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Page 214 and 215: Answers to c ase s tudy q uestions
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Page 218 and 219: 208 Glossary of dermatological term
Page 220 and 221: 210 Glossary of dermatological term
Page 222 and 223: Index Page numbers in italics indic
Page 224 and 225: 214 Index candidiasis 36-38, 159, 1
Page 226 and 227: 216 Index erythromycin 20, 21, 22,
Page 228 and 229: 218 Index lentigo maligna 90, 91, 2
Page 230 and 231: 220 Index phaeomelanins 6, 110 phen
Page 232 and 233: 222 Index stanozolol 180 staphyloco
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224 Index women scalp hair loss 117
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Lecture Notes Dermatology - Graham-Brown, Robin, Burns, Tony

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