Maculopapular Rashes

Although immediate reactions of anaphylaxis, bronchospasm, and urticaria have been reported, most commonly patients exhibiting an adverse reaction develop a maculopapular rash, usually after several days of therapy. They may also develop fever and eosinophilia (80,219). Cefoperazone (34) and ceftriaxone (39), having greater biUary excretion than other cephalosporins, are associated with an increased risk of diarrhea, which may be caused by selection of cytotoxin producing stains of Clostridium difficile (219). 

Antithyroid drags have several side effects. The most frequent side effects are maculopapular rashes, pruritus, urticaria, fever, arthralgia and swelling of the joints. They occur in 1-5% of patients [1, 2]. Loss of scalp hair, gastrointestinal problems, elevations of bone isoenzyme of alkaline phosphatase and abnormalities of taste and smell are less common. The incidence of all these untoward reactions is similar with MMI and PTU. Side effects of MMI are dose-related, whereas those of PTU are less clearly related to dose [1]. PTU may cause slight transient increases of serum aminotransferase and y-glutamyl transpeptidase concentrations but also severe hq atotoxicity whereas methimazole or carbimazole can be associated with cholestasis. The side... 

Measles is a severe, highly contagious, acute infection that frequently occurs in epidemic form. After multiplication within the respiratory tract the virus is transported throughout the body, particularly to the skin where a characteristic maculopapular rash develops. Complications ofthe disease can occur, particularly in malnourished children, the most serious being measles encephalitis which can cause permanent neurological injury and death. 

Dermal Effects. Some of the people in Woburn, Massachusetts, who had been chronically exposed to trace amounts of trichloroethylene and other substances in the drinking water reported skin lesions (Byers et al. 1988). These were maculopapular rashes that were said to occur approximately twice yearly and lasted 2-4 weeks. These skin conditions generally ceased 1-2 years after cessation of exposure to contaminated water. The limitations of this study are discussed in Section 2.2.2.8. A case study was published of a 63-year-old rural South Carolina woman exposed to trichloroethylene and other chlorinated hydrocarbons in her well water, who developed diffuse fascitis, although her husband did not (Waller et al. 1994). The level of trichloroethylene measured in the well water was 19 mg/L. Substitution of bottled water for drinking resulted in improved symptoms. 

Maculopapular rash—a rash that contains both macules and papules. A macule is a flat discolored area of the skin, and a papule is a small raised bump. A maculopapular rash is usually a large area that is red and has small, confluent bumps. 

Delayed reactions with radiocontrast media occur in 1% to 3% of patients.21 Although reactions occasionally are severe, most are mild and manifest as maculopapular rashes, fixed eruptions, erythema multiforme, and urticarial eruptions. 

Mild to moderate rash diffuse maculopapular rash with or without pruritus severe rash see section on Stevens-Johnson syndrome (SJS)... 

Acute GVHD usually is not evident until the time of engraft -ment, when donor lymphoid elements begin to proliferate. The primary targets of immune-mediated destruction of host tissue by donor lymphocytes in acute GVHD are the skin, liver, and GI tract.44 A diffuse maculopapular rash on the face, truck, face, extremities, palms, soles, and ears is the usual sign of acute GVHD of the skin. In more severe cases, it can... 

Skin Poikiloderma Lichen planus-like features Sclerotic features Morphea-1 ike features Lichen sclerosus-like features Depigmentation Seat impairment Ichthyosis Keratosis pilaris Hypopigmentation Hypergimentation Erythema Maculopapular rash Pruritus... 

Hydroxyurea -antimetabolite inhibits ribonucleotide reductase cell cycle specific -bone marrow suppression -nausea and vomiting (uncommon at standard doses) -maculopapular rash -skin ulceration -megaloblastosis (elevated MCV)... 

Trimetrexate -antifolate antimetabolite -bone marrow suppression -mucocutaneous effects (mucositis, stomatitis) -nausea and vomiting -fever -maculopapular rash—usually self-limited -anorexia, malaise -above toxicities increased in patient with hypoalbuminemia (<3.5)... 

Signs and Symptoms Self limiting febrile disease. Symptoms include arthritis in wrist, knee, ankle, and small joints of extremities typically followed by a maculopapular rash in 1-10 days. Swelling of the cheeks and palate can occur. May present hemorrhagic symptoms. Recovery may be prolonged. 

Signs and Symptoms Most infections are asymptomatic or produce a nonspecific flulike illness. Symptoms include mild fever, headache, swollen lymph nodes, mental confusion, tremors, and flaccid paralysis. Liver and/or spleen may be enlarged. A maculopapular rash may be present on the trunk of the body. May progress to encephalitis and/or meningitis (meningoencephalitis) producing changes in mental status, seizures, and coma. 

Signs and Symptoms Sudden onset of fever, headache, conjunctival congestion, generalized aches, swollen, painful lymph nodes, and inflammation of the lung tissue (pneumonitis). A dull red to dark purple maculopapular rash appears first on the trunk then spreads to the arms and legs. Can progress to pulmonary, encephalitic, and/or cardiac complications. 

Minor adverse reactions include pruritic maculopapular rashes, arthralgias, fever, and a benign transient leukopenia (white blood cell count less than 4,000/mm3). The alternate thiourea may be tried in these situations, but cross-sensitivity occurs in about 50% of patients. 

Valley fever is a syndrome characterized by erythema nodosum and erythema multiforme of the upper trunk and extremities in association with diffuse joint aches or fever. Valley fever occurs in approximately 25% of infected persons, although, more commonly, a diffuse mild erythroderma or maculopapular rash is observed. 

Adverse drug reactions may be characterised by urticaria, fever or maculopapular rashes. 

Monotherapy in pediatric patients not previously treated with other AEDs -Approximately 9.2% of 152 pediatric patients discontinued treatment because of an adverse experience. The adverse experiences most commonly associated (at least 1%) with discontinuation were rash (5.3%) and maculopapular rash (1.3%). 

Rash Mild to moderate rashes including urticarial rash, maculopapular rash, and possible photosensitivity have been reported in subjects receiving tipranavir/ritonavir. Hemophilia There have been reports of increased bleeding, including spontaneous skin hematomas and hemarthrosis in patients with hemophilia type A and B treated with Pis. 

Adverse reactions occurring in at least 3% of patients include the following Headache fatigue nausea diarrhea increased ALT and AST rash maculopapular rash neutropenia increased amylase pruritus. 

Pruritic maculopapular rash possibly accompanied by malaise, fever, chills, joint pain, nausea, and vomiting should be considered a toxic reaction. 

Of particular importance in tfie geriatric patient Drowsiness, malaise, headache, nausea, diarrhea, maculopapular rash, hypersensitivity reactions—fever, exfoliafive der-mafifis, liver function abnormalities, renal impairment, eosinophilia... 

Mild to moderate Maculopapular rash (27%) nausea, fatigue, headache, diarrhea, fever, cough (less than 26%) (moderate symptoms may interfere with daily activities)... 

Diarrhea or constipation, indigestion, nausea, maculopapular rash, dermatitis, dizziness, headache... 

A variety of relatively uncommon dermatological side effects have been noted to be associated with antipsychotic agents. These include maculopapular rashes, urticaria, and erythema multiforme (Arana, 2000). Photosensitivity and skin pigmentation can also occur during treatment with these drugs. Although skin pigmentation has been most frequently reported with chlorpromazine, this can occur with thioridazine and trifluoperazine (Harth and Rapoport, 1996). In addition, treatment-induced alopecia has been reported for haloperidol, olanzapine, and risperidone (Mercke et ah, 2000). 

A maculopapular rash develops in 5%-10% of patients taking lamotrigine, usually in the first 8 weeks of treatment. Serious rashes requiring hospitalization and discontinuation of treatment may occur. The incidence of these rashes, which have included Stevens-Johnson syndrome, is approximately 0.08% (0.8 per 1,000). Stevens-Johnson syndrome is potentially fatal. Patients must be advised of this risk and of the necessity to call the office at once if they develop a rash. Development of a rash with concomitant systemic symptoms is a particularly ominous sign, and the patient should be evaluated immediately. 

Adverse effects include hypersensitivity reactions, maculopapular rash, urticaria, myalgia, malaise fever, transient leucope-nia or leukocytosis, hepatic damage, nausea, vomiting, diarrhoea, headache and drowsiness. 

Coenzyme Q10 is well tolerated, rarely leading to any adverse effects at doses as high as 3000 mg/d. In clinical trials gastrointestinal upset, including diarrhea, nausea, heartburn, and anorexia have been reported with an incidence of less than 1%. Cases of maculopapular rash and thrombocytopenia have very rarely been observed. Other rare adverse effects include irritability, dizziness, and headache. 

Although immediate reactions of anaphylaxis, bronchospasm, and urticaria have been reported, most commonly patients exhibiting an adverse reaction develop a maculopapular rash, usually after several days of therapy. They may also develop fever and eosinophilia. 

A 67-year-old woman had a fatal reaction 1 week after she started to take fluvastatin 20 mg/day. When the drug was withdrawn 10 weeks later, she had arthralgia, myalgia, an erythematous maculopapular rash, and breathlessness due to a widespread alveolitis (6). 

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