Overview
In Generalised Exfoliative Dermatitis (GED), there is generalized inflammation of more than 90% of the skin surface, which may appear as widespread skin redness and scaling. Itch is usually present. Some patients may have associated swelling of lymph nodes, liver and spleen.
Causes
Drugs which can cause this kind of reaction include anti-TB medications.
Typically, GED occurs 1 to 6 weeks after initiation of the culprit drug. Complications such as inability to control one’s body temperature, blood fluid and electrolyte imbalance, infection and heart failure can occur.
Prognosis is usually good after withdrawal of the offending drug.
Prevention
What is a drug provocation test?
A drug provocation test is the controlled administration of a drug to diagnose an immune-mediated and non–immune-mediated drug reaction. It is usually done under medical supervision. Drug provocation test has the potential risk of inducing a more severe and uncontrollable relapse of the original reaction. It is therefore a test which should be reserved for specific situations and when the benefits outweigh the risks.
Detection & Treatment
Evaluating drug allergies/ cutaneous adverse drug reactions can be challenging. An accurate, detailed history and clinical examination will help to establish the type of CADR and to identify the culprit drug. Blood tests, skin biopsies and skin tests (eg. Skin prick tests, intradermal tests and patch tests) are sometimes needed in the evaluation, but the usefulness of these tests is dependent on the type of the reaction and the drugs involved.
Not all cases of drug allergies/ cutaneous adverse drug reactions require specific drug allergy testing and not every medication or type of CADR has a blood test or skin test to help in the diagnosis.
Oral corticosteroids may be necessary in severe cases.
Care Management
After a drug allergy or hypersensitivity has been diagnosed, what should you do?
It is important to remember the drug(s) which you are allergic to and always inform your doctors about it. A wallet-size card stating the name of the drug and the reaction you had would be most useful in case of emergency. Avoidance of drugs which are you are allergic to will prevent unnecessary morbidity or mortality.
Drug allergies are captured on the electronic medical records that link many hospitals and clinics.
Specialties & Services
