REACTION | APPEARANCE | CAUSATIVE DRUGS |
Exanthema | Maculopapular(flat/slightly raised in pimples), scarlatiniform/rubelliform(red) pruritic(itchy) lesions | Benzodiazepines (BZDs) Carbamazepine, Valproate, Lamotrigine |
Urticaria | Erythematous(red), pruritic(itchy) wheals. May progress to angio-oedema and anaphylaxis | Benzodiazepines (BZDs) Carbamazepine, Valproate |
Fixed drug eruptions | Reddened round lesions which blister and crust. Hyperpigmentation may be permanent. Lesions tend to present in same location if rechallenge performed | BZDs and carbamazepine |
Bullous reactions | Blisters and vesicles; may be part of more generalised CDR such as vasculitis or EM complex* | Carbamazepine |
Lichenoid reactions | Flat violaceous papules resembling lichen planus | Carbamazepine |
Alopecia | Hair loss,Thinning hair | Carbamazepine, vigabatrin, valproate, BZDs |
Pigmentation changes | Colour changes may affect skin, hair, nails, mucous membranes; may be permanent | BZDs, Valproate |
Photosensitivity | Abnormal sensitivity to UVA or UVB (photoallergy); may result in severe sunburn | Carbamazepine ; BZDs |
Exfoliative dermatitis | Generalised redness, pruritus and eczema with exfoliation(skin peeling off); may affect whole body; also: fever, chills, lymphadenopathy, malaise | Carbamazepine, diazepam , valproate |
Vasculitis | Small haemorrhagic macules coalescing to larger blisters and ulcers; fever, malaise, joint/muscle pain | BZDs, Carbamazepine, Valproate |
Anticonvulsant hypersensitivity syndrome | Multiorgan syndrome affecting skin (exanthematous pustulation), fever, lymphadenopathy, leucocytosis(raised white cell count), hepatitis, nephritis(kidney inflammation), thrombocytopenia(low platelets), myopathy, anorexia, anaemia, pulmonary infiltrates(lung) | |
Erythema multiforme (EM) complex* | Sudden onset skin eruption(morbilliform) with stomatitis, vesicles around lips and oral mucosa, fever, muscle pains, ocular involvement (SJS) and exfoliation 1-15% in SJS or >15% TEN of skin area | Carbamazepine, valproate |
Erythema nodosum | Painful erythematous subcutaneous nodules; fever, malaise; general symptoms may persist for years. | Carbamazepine |
SJS= Stevens- Johnson Syndrome; TEN= Toxic Epidermal Necrolysis
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