Rash

QHgNiOiS. Colourless crystals, m.p. 164 5-166-5" C. It is usually prepared by treating p-acetamidobenzenesulphonyl chloride with ammonia, and hydrolysing the acetyl derivative to the base. Used for the treatment of streptococcal infections, gonorrhoea, meningococcal meningitis and urinary infections. Liable to cause unpleasant reactions, such as nausea, cyanosis and skin rashes. 

Since the introduction of cortisone (1) (1948) and hydrocortisone (2) (1951), adrenal-cortical hormones have remained an important and unreplaced dmg class. Though not without adverse effects, these compounds have continued to be the dmg of choice in the treatment of afflictions ranging from the moderate skin rash to severe acute inflammatory disorders, and are included in many other therapeutic regimes. 

Repeated exposures to acryhc monomers can produce allergic dermatitis (or skin sensitization) resulting in rash, itching, or sweUing. After exposure to one monomer, this dermatitis may arise upon subsequent exposure to the same or even a different acryhc monomer. 

The oxa2ohdinedione trimethadione [127-48-0] C H NO (50), at one time the dmg of choice for the treatment of absence sei2ures, has been replaced by ethosuximide (41) and valproate (49). (50) has a distinct profile from that of phenytoin but causes photophobia and night blindness in approximately 30% of the patients taking it and has the CNS and sedative properties seen for other anticonvulsants together with moderate neutropenia, hepatitis, and skin rashes (13). Trimethadione does not appear to produce its effects via modulation of GABA-mediated responses. 

Adverse side effects of gold treatments include stomatitis, rash, and proteinuria. Complete blood counts and urinalysis should be performed before each or every other injection of gold compounds. Pmritic skin rash and stomatitis are more common adverse effects that may resolve, if therapy is withheld for a few weeks and then restarted cautiously at a lower dose. Oral gold causes less mucocutaneous, bone marrow, and renal toxicity than injectable gold, but more diarrhea and other gastrointestinal reactions appear. 

Penicillamine (29) can be effective in patients with refractory RA and may delay progression of erosions, but adverse effects limit its useflilness. The most common adverse side effects for penicillamine are similar to those of parenteral gold therapy, ie, pmritic rash, protein uria, leukopenia, and thrombocytopenia. Decreased or altered taste sensation is a relatively common adverse effect for penicillamine. A monthly blood count, platelet count, and urinalysis are recommended, and also hepatic and renal function should be periodically monitored. Penicillamine is teratogenic and should not be used during pregnancy. 

Ghpi2ide is relatively free of serious adverse effects and only approximately 1.5% of patients discontinue this dmg because of adverse reactions. Gastrointestinal disturbances are most common (incidence 1.7—3.7%) skin rashes occur in up to 1.4% of patients. 

The incidence of serious side effects with glyburide, sold as DiaBeta and Micronase, is low. Gastrointestinal disturbances develop in 1.8% of patients. Skin rashes occur in 1.5% of patients and may disappear with continued use. 

Uncured resins are skin sensitizers and contact should be avoided, as weU as breathing the vapor, mist, or dust. Novolak-based pulverized products generally contain hexamethylenetetramine, which may cause rashes and dermatitis. PhenoHc molding compounds and pulverized phenoHc adhesives must be controUed as potentially explosive dusts. In addition, they contain irritating or toxic additives. 

Strong acids and strong alkaUes can severely bum the skin, chromium compounds can produce skin rashes, and repeated exposure to solvents causes removal of natural oils from the skin. Infection is always a concern for damaged skin. Absorption through the skin is possible for materials that are appreciably soluble iu both water and oil, eg, nitrobenzene, aniline, and tetraethyllead. Other materials can be absorbed if first dissolved iu extremely good solvents, eg, dimethyl sulfoxide. Subcutaneous iujection can occur accidentally by direct exposure of the circulatory system to a chemical by means of a cut or scratch or iuadvertent penetration of the skin with a hypodermic needle. 

Tb allium intoxication during the first trimester of pregnancy can cause skeletal deformities, alopecia, rash, low birth weight, and premature birth (38). 

Skin Irritation in Spas/Hot Tubs. A common skin irritation contacted in spas and hot tubs is a nonpmritic rash due to P. aeruginosa (67—70). Some cases of skin irritation have also been associated with use of bromine sanitizers. Skin infections may be enhanced by the high water... 

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). 

The penicillins in general, ate renowned for their lack of toxicity. The most common adverse effect of the use of penicillins is an allergic reaction which can change from a mild rash to fatal anaphylactic shock in rate cases. AH penicillins cross the placenta and ate excreted in maternal milk. However, the relative freedom from toxicity tenders these compounds valuable agents during pregnancy and lactation. 

Since about 85% of the administered dose is passed unchanged in the feces of the patient, selective toxicity of the dmg can be attributed primarily to poor absorption. Side effects include abdominal pain, nausea, vomiting, diarrhea, loss of appetite, headaches, and vertigo or drowsiness. Skin rashes can also develop. Pyrantel pamoate is produced by Pfi2er, Inc., New York, New York. 

Systemic reactions are less severe than with diethylcarbama2ine. The most commonly seen reactions are fever, rash, and lymph-node pain or swelling. Suppressive ivermectin therapy consists of a single oral dose every 6—18 months. The required duration of suppressive therapy is unknown, probably at least three years (36). Ivermectin is available from the CDC Dmg Service on request. It is manufactured by Merck Sharp and Dohme in the United States and England. 

Carbarsone (Amebarsone) was once widely used for the treatment of intestinal amebiasis. Like other arsonic acids, however, carbarsone may cause skin rashes and even damage to the vision. Although it is stiU available for medicinal use, it is really obsolete as an amebicide because less toxic and more effective nonarsenicals are now available (174). 

Skin Irritation. Fine broken filaments often irritate the skin, occasionally causing transient itching and rashes. The back of hands and wrists and neck areas tend to be most sensitive. Protective clothing and barrier skin creams help prevent the fiber from reaching the skin and causing discomfort. 

About 30% of the patients on chronic procainamide dosing develop a systemic lupusfike syndrome consisting of arthralgia, myalgia, skin rash, and fever. Patients who are slow acetylator phenotypes may be prone to this condition. Some may exhibit pleuropneumonic involvement and hepatomegaly... 

Phenytoin s absorption is slow and variable yet almost complete absorption eventually occurs after po dosing. More than 90% of the dmg is bound to plasma protein. Peak plasma concentrations are achieved in 1.5—3 h. Therapeutic plasma concentrations are 10—20 lg/mL but using fixed po doses, steady-state levels are achieved in 7—10 days. Phenytoin is metabolized in the fiver to inactive metabolites. The plasma half-life is approximately 22 h. Phenytoin is excreted primarily in the urine as inactive metabolites and <5% as unchanged dmg. It is also eliminated in the feces and in breast milk (1,2). Prolonged po use of phenytoin may result in hirsutism, gingival hyperplasia, and hypersensitivity reactions evidenced by skin rashes, blood dyscrasias, etc... 

Some rare toxic effects that may result from tocainide therapy are a lupus-fike syndrome, skin rash, pulmonary complications, and hematologic abnormalities, eg, agranulocytosis (1,2,24). 

The side effects or toxic effects that the calcium antagonists have in common are hypotension, facial flushing, headache, di22iness, weakness, sedation, skin rash, edema, constipation, and abdominal discomfort (nausea, vomiting, and epigastric pressure). 

ACE inhibitors can be administered with diuretics (qv), cardiac glycosides, -adrenoceptor blockers, and calcium channel blockers. Clinical trials indicate they are generally free from serious side effects. The effectiveness of enalapril, another ACE inhibitor, in preventing patient mortaUty in severe (Class IV) heart failure was investigated. In combination with conventional dmgs such as vasodilators and diuretics, a 40% reduction in mortaUty was observed after six months of treatment using 2.5—40 mg/d of enalapril (141). However, patients complain of cough, and occasionally rash and taste disturbances can occur. 

Human incidents have been reported in workers involved in the production or uses of PCNs. In the United States as well as in Germany and Austraha, the severity of the PCN-induced toxicosis was higher after exposure to the higher chlorinated PCN mixtures. In humans the inhalation of hot vapors was the most important route of exposure and resulted in symptoms including rashes or chloracne, jaundice, weight loss, yellow atrophy of the hver, and in extreme cases, death (75,77—79). 

The water solubiUty of glutaric acid fosters its toxicity. Glutaric acid is a known nephrotoxin. Renal failure has been documented ia rabbits adruinistered sodium glutarate subcutaneously (124). Dibasic ester (Du Pont), which contains primarily dimethyl glutarate, has low acute toxicity by inhalation and by ingestion, and is moderately toxic via dermal absorption. The acid is both a dermal and ocular irritant of humans. The ester is a severe skin irritant and may cause a rash ia humans (120). 

Caution should be taken when using glutaraldehyde. Gloves and aprons should be worn and adequate ventilation provided. It has been reported to produce contact dermatitis, eye irritation, nausea, headache, rashes, and asthmatic reaction (125). 

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