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Acute erythematous rash on the trunk and limbs
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
A papular eruption occurring in children between the ages of 6 months and 12 years, which is usually a response to a viral infection especially hepatitis B. A profuse papular rash starts on the buttocks and thighs, and quickly spreads over 3–4 days to the arms and face. The lesions may be a dull red colour. There is often an associated lymphadenopathy of inguinal and axillary glands. The rash fades after 2–8 weeks. Always check the LFTs.
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
In a similar study, 4 of 85 patients discontinued treatment after 5-15 weeks because of localised skin reactions (erythema, vesiculation, and/or infiltration); contact allergy was confirmed by patch testing. An additional patient first had a localised skin reaction and later developed a generalized papular rash (5). Of 20 patients on long-term clonidine-TTS treatment, 10 (50%) stopped the therapy because of localized skin rashes. Five of them were tested (probably some sort of patch testing, ‘clonidine in petrolatum’) and all developed a skin rash at the test site. Oral clonidine in 2 was well tolerated (9).
Test of time and test of treatment
Published in Caroline J Rodgers, Richard Harrington, Helping Hands: An Introduction to Diagnostic Strategy and Clinical Reasoning, 2019
Caroline J Rodgers, Richard Harrington
There is a papular rash with excoriations, erythema and scale. There is some evidence of lichenification and the rash is predominantly affecting the area around the finger webs (interdigital spaces) and knuckles; it is bilateral. The nails appear normal and in good condition.
Cutaneous irritancy of an ibuprofen medicated plaster in healthy volunteers
Published in Postgraduate Medicine, 2018
Manisha Maganji, Mark P. Connolly, Aomesh Bhatt
As described above, one subject had a serious AE of a ruptured tendon that was not considered related to treatment. Two subjects had significant AEs. One subject experienced, during the 2-week washout period, a papular rash on her trunk for only the first day, which may have started from the plaster on the left side of her back. The subject was not exposed to the challenge plasters. The rash resolved over a 2-month period without treatment. The Investigator considered the skin reaction probably related to treatment. The other subject, on her first dermal assessment during the induction phase of the study, scored a Grade 4 at both the ibuprofen and placebo plaster sites, and consequently treatment was discontinued. During the challenge phase, at the first dermal assessment, the subject scored a Grade 7 (strong erythema, edema, and papules) and both sites were itchy. The fact that Grade 4 dermal AE occurred at both the ibuprofen and placebo plaster sites indicates it was likely due to sensitivity to the components of the matrix and/or adhesive and was not due to ibuprofen. The subject was prescribed chlorphenamine 4 mg for 3 days, and the skin reaction resolved and did not return for the rest of the study. The Investigator considered the reaction definitely related to therapy.
Acute generalized exanthematous pustulosis: a rare side effect of clindamycin
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Sijan Basnet, Rashmi Dhital, Biswaraj Tharu
The patient is a 71-year-old lady seen in primary care physician’s office for non-improvement of diffuse rash that started 2 days prior to completing a 10-day course of clindamycin for a tooth infection. Her rash had been present for 10 days on presentation. She noted erythematous papules and pustules that started on her neck and then quickly spread to her chest and arms over 2 days. They were slightly itchy. She had gone to an urgent care where she was prescribed an 8-day course of prednisone taper. On questioning, she mentioned that she had noted clearing of the rash from the neck region where it had first appeared. She had not noted any mucosal involvement. She did not have any fever or chills. She denied shortness of breath, wheezing or chest tightness. Her past medical history was significant for hypertension and hyperlipidemia. She did not have a known history of psoriasis or any other skin condition. Her home medications included hydrochlorothiazide 12.5 mg daily, meloxicam 15 mg daily, omeprazole 20 mg daily, simvastatin 20 mg nightly, and alprazolam 0.25 mg p.r.n. nightly. None of her home medications were new or had been recently changed and were continued during prednisone use. On examination, her temperature was 98.2 ºF, pulse 96 beats per minute, blood pressure 137/78 mm Hg, and respiratory rate 12 breaths per minute. The patient had a generalized papular rash that coalesced to form plaques on her arms and was studded with non-follicular pustules, along with skin desquamation (Figure 1). Superimposed bacterial skin infection was not noted. She did not have any cervical, axillary or inguinal lymphadenopathy. System examination was unremarkable. Given history of recent clindamycin use and presentation, acute generalized exanthematous pustulosis (AGEP) was suspected. The patient was reassured about the benign nature of the illness and recommended to complete the prednisone taper. She was advised to use fexofenadine as needed for itching. Her complete blood count was within normal range except for an elevated white count of 13.7 10E3/µL (reference range: 4.8–10.8 10E3/µL) with 76.2% (reference range: 37–75%) neutrophils related to prednisone use. Her liver function test was unremarkable. Skin biopsy was not done as it was most likely thought to be related to recent clindamycin use. The patient noted complete resolution of rash in a month on follow up.