Other Skin Reactions Produced by Analgesics

In 1894 Brocq described a special type of drug reaction which cleared up rapidly when the drug was stopped, and reappeared in the same clinical distribution when the drug was restored. The incriminated drug was antipyrine. The mechanism of fixed eruptions is unknown (Amos 1976). 

The generalized form of eczema, sometimes called exfoliative dermatitis or ery-throdermia has also been associated with phenylbutazone, ibuprofen, mefenamic acid, and phenacetin (see Sect. C. VIII). 

Many hepatotoxic reactions result from a common initiating event - the metabolic activation in the body of drugs that are chemically stable to potent alkylating or arylating agents. Paracetamol may be used as an example of this type of reaction (Prescott et al. 1974) if it is taken in excess (more than 15 g) with suicidal intent, it produces a clinical, laboratory and pathologic syndrome of severe, acute, and usually fatal hepatic necrosis. 

The hypersensitive and toxic mechanisms are not mutually exclusive. In some instances, a combined effect might by operating, with antigens being produced only in some subjects because of altered drug metabolism (Klatskin 1974). In addition, a direct toxic mechanism might also alter an immune response, exposing the cell to further injury. 

The effect of analgesics on the kidney is particularly important because, except in certain countries, there is no strict medical control over their consumption. In 1953 Spuhler and Zollinger focused attention on analgesics as causative agents in 

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