Dermatological adverse drug effects

Unithiol has been reported to have a low overall incidence of adverse effects (< 4%). Self-limited dermatologic reactions (drug exanthems or urticaria) are the most commonly reported adverse effects, although isolated cases of major allergic reactions, including erythema multiforme and Stevens-Johnson syndrome, have been reported. Because rapid intravenous infusion may cause vasodilation and hypotension, unithiol should be infused slowly over an interval of 15-20 minutes. 

Iatrogenic telangiectasis is a poorly understood dermatological adverse effect of several drugs, including cephalosporins (143,148). Telangiectasiae localized to light-exposed areas, as in this case, have been described with some calcium channel blockers (149,150). 

Dermatological adverse effects are not uncommon with griseofulvin and are of considerable variety. The following have been described urticaria (28,29), photosensitivity eruptions (30), erythema multiforme (31), morbilliform rashes (32), serum sickness-like reactions (33), fixed drug eruption (29,34,35), Stevens-Johnson syndrome (36), vasculitis (37), toxic epidermal necrolysis (38,39), and lupus erythematosus (40,41). 

Two reports from India again stressed the fact that serious dermatological adverse effects are not uncommon with this compound. Bhagi et al. (50 -) reported a case of severe acute epidermal necrolysis developing in a 25-year-old woman treated for 6 weeks with streptomycin and isoniazid followed by 15 days of thiacetazone (150 mg daily) and isoniazid. The patient recovered on withdrawal of the drugs and local and systemic treatment with corticosteroids, and was subsequently treated satisfactorily with a combination of isoniazid and para-aminosalicylic acid. 

Lamotrigine is not approved for the acute treatment of depression, and the dose must be started low and slowly titrated up to decrease adverse effects if used for maintenance therapy of bipolar I disorder. A drug interaction and a severe dermatologic rash may occur when lamotrigine is combined with valproate (i.e., lamotrigine doses must be halved from standard dosing titration). 

Fluorination of corticosteroids at C-9 or/and C-6 increases glucocorticoid activity, while mineralocorticoid activity, responsible for sodium retention (the main adverse effect of corticoids), is decreased (cf. Chapter 4). Fluorocorticoster-oids were the first fluorinated compounds to be used clinically. They are still major drugs against many inflammatory disorders rheumatoid polyarthritis, ORL (asthma, rhinitis), brain edema, dermatological, allergies, anaphylactic shock, Quincke s edema). 

Severed drugs commonly used in dermatology should be monitored regularly for (principally systemic) adverse effects. These include ... 

Ernst E. Adverse effects of herbal drugs in dermatology. Br J Dermatol 2000 143(5) 923-9. 

Cyclophosphamide has many adverse effects, including the risk of secondary malignancy and myelosuppression, and thus is used only in the most severe, recalcitrant dermatological diseases. The secondary malignancies have included bladder, myeloproliferative, and lymphoproUferative malignancies and have been seen with the use of cyclophosphamide alone or in combination with other antineoplastic drugs. 

The majority of adverse effects to sulfonamides are mild in nature and reversible, although idiosyncratic drug reactions may occur. Urinary tract disturbances, including sulfonamide crystalluria and hematuria, can be minimized in susceptible animals by maintaining an adequate water intake to maintain a high urine flow. Bone marrow depression and dermatologic reactions have also been associated with sulfonamide therapy in animals. 

De Groot AC, Frosch PJ (1997) Adverse reactions to fragrances. A clinical review. Contact Dermatitis 36 57-86 De Groot AC, Weyland JW, Nater JP (eds) (1994) Contact allergy to fragrance materials. In Unwanted effects of cosmetics and drugs used in dermatology, 3rd edn. Elsevier, Amsterdam, Chap. 5.8-5.15, pp 65-72... 

Reports of the non-antimicrobial effects of tetracyclines continue to appear, and the clinical uses of non-antimicrobial tetracyclines in dermatology have been highlighted [119 ]. In general, when these drugs are used for non-infectious conditions, adverse reactions seem to be of same types and frequencies as when they are used as antimicrobial agents. However, the adverse effects profiles of the chemically modified tetracyclines have still not been properly elucidated. 

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