Cutaneous Drug Reactions
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Cutaneous Drug Reactions
Olivier M. Chosidow
Robert S. Stern
Bruce U. Wintroub
Cutaneous reactions are among the most frequent adverse reactions to drugs. Prompt recognition of these reactions, drug withdrawal, and appropriate therapeutic interventions can minimize toxicity. This chapter focuses on adverse cutaneous reactions to drugs other than topical agents and reviews the incidence, patterns, and pathogenesis of cutaneous reactions to drugs and other therapeutic agents.
Contact dermatitis and other occupational skin diseases
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Contact dermatitis and other occupational skin diseases
Contact dermatitis
Contact dermatitis is by far the most common form of occupational skin disease and is an important source of time lost from work and a long-term disability. Contact dermatitis is caused by external agents, which may be present at home, at work or at play. Contact dermatitis has an irritant rather than an allergic cause in at least 70% of patients. It is not easy to separate the irritant from the allergic causes by the clinical or histological appearance of the lesions. Irritants may cause damage by either once only exposure to the high concentration of an irritating chemical or, more commonly, repeated exposures to low concentrations of minor irritants.
Chlamydial Infections
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Chlamydial Infections
Walter E. Stamm
The genus Chlamydia contains three species that infect humans: Chlamydia psittaci, C. trachomatis, and C. pneumoniae (formerly the TWAR agent). C. psittaci is widely distributed in nature, producing genital, conjunctival, intestinal, or respiratory infections in many mammalian and avian species. Genital infections with C. psittaci have been well characterized in several species and cause abortion and infertility. Although mammalian strains of C. psittaci are not known to infect humans, avian strains occasionally do so, causing pneumonia and the systemic illness known as psittacosis.
Connective tissue disorders
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Connective tissue disorders
Connective tissue disorders are a heterogenous group of conditions that affect multiple organ systems, including the skin, and are characterised by diverse patterns of autoantibody production. While the disorders may have overlapping and shared clinical features, there are often distinctive, and sometimes diagnostic, cutaneous findings.
Lupus erythematosus
Blistering disorders
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Blistering disorders
Blistering or vesiculobullous disorders constitute a diverse group of conditions in which fluid accumulates in the skin as a result of damage to the epidermis, epidermo-dermal junction or the upper dermis. Although clinical patterns may be very helpful, diagnosis usually requires histology and immunofluorescence. Immunofluorescence requires a fresh specimen in a special medium as stipulated by the laboratory.
Most rare causes of blistering (see Table 1) are not dealt with in these guidelines. The uncommon and rarer causes would usually be dealt with by a specialist.
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