Contact allergy erythema multiforme

Rashes of aU types may be caused by allergy to peniciUin. Henoch-Schonlein purpura with renal involvement has been a rare complication. Contact dermatitis is observed occasionally in pharmacists, nurses, and physicians who prepare penicilUn solutions. Fixed-drug reactions also have occurred. More severe reactions involving the skin are exfoliative dermatitis and exudative erythema multiforme. The incidence of rashes appears to be highest foUowing the use of ampicUlin ( 9%) rash follows the administration of ampiciUin in nearly all patients with infectious mononucleosis. 

The most frequent manifestations of drug allergy involve the skin. Urticaria, angioedema, exanthematous skin rashes, allergic eczematous contact dermatitis, photodermatitis, fixed drug eruptions, erythema multiforme, and the Stevens-Johnson and Lyell syndromes are the best characterized clinical manifestations. Their clinical aspects, evolution, and pathophysiological mechanisms are described in detail in the following chapter. 

Penicillin is a potent topical sensitizer and may cause contact dermatitis (Levine 1960 a Fellner 1976) it is therefore no longer used in ointments. Several other cutaneous manifestations of penicillin allergy, such as fixed drug eruption, erythema multiforme, the Stevens-Johnson syndrome, exfoliative dermatitis, epidermal necrolysis, erythema nodosum and cutaneous necrotizing angiitis have been described (Fellner 1976 Soter and Austen 1978 Wintraub et al. 1979 De Swar-TE 1972). The precise immunological mechanisms of these various forms of cutaneous reactions are usually not known. 

Goh (1988) reported erythema multiforme-like eruption in a worker with contact allergy to trinitrotoluene who was employed at an ammunitions factory. The systemic absorption of trinitrotoluene appeared low as its urinary metabolite, dinitroaminotoluene, was not detected. Patch test to trinitrotoluene gave a strong eczematous reaction. 

Garcia-Bravo B, Rodriguez-Pichardo A, de-Pierola SF, Camacho F(i995) Airborne erythema-multiforme-like eruption due to pyrethrum. Contact Dermatitis 33 433 Goh CL (1988) Erythema multiforme-l e eruption from trinitrotoluene allergy. Int J Dermatol 27 650-651 Goh CL (1989) Urticarial papular and plaque eruption. A manifestation of allergic contact dermatitis. Int J Dermatol 28 172-176... 

Terekhova NY, Wushkina TP (1977) The syndrome of erythema exsudativum multiforme as a manifestation of drug allergy. Vestn Dermatol Venerol 10 66-68 Veien NK, Hattel T, Justesen O, Norholm A (1980) Occupational contact dermatitis due to spiramycin and/or tylosin among farmers. Contact Dermatitis 6 410-413 Virgilio R (1973) Rifampicin-dependent antibodies during intermittent treatment. Scand J Respir Dis [Suppl] 84 83-86... 

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