lq2006
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A 24-year-old professional gardener comes to the office because of a generalized, maculopapular, itchy rash that developed a few days ago. The itching is keeping him awake at night. Three weeks ago he began treatment for a seizure disorder with 400 mg of phenytoin, daily. Physical examination now shows a generalized maculopapular rash with excoriations. The most appropriate management at this time is discontinuation of the drug and addition of which of the following?
A) Oral hydroxyzine
B) Oral prednisone
C) Topical betamethasone
D) Topical emollients
E) Topical hydrocortisone
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| peter90036
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oral prednisone? or... is this drug-SLE (-do SLE tx apply ? - hydroxizine for skin)
Edited by peter90036 on 05/17/08 - 09:40 AM
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| hottie99
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yeah but i think the questionis asking what u give instead of the phenytoin, so isn't the best next management to treat the rash would bethe topical hydrocortisone?? i dont remember this question on nbme 5, i thought ck only has 3 forms?? regardless.. i'd pick E
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| Vietnamese
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B- Oral prednisone
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Nothing is impossible.
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| nyimalay
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B
Generalized rash with excoriations. Might be Steven Johnson Syndrome or toxic epidermal necrolysis.
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| drhouse
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B
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everybody can do it.... its just matter of time
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| peter90036
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Tx of anticonvulsant hypersensitivity syndrome
- is supportive
- Discontinue phenytoin /other inciting medications (carbamazepine, phenobarb).
- Consult rheumatologist /dermatologist is advised.
- Glucocorticoids are often used , may be helpful, but ther's no conclusive evidence.
Tx of Drug-SLE (phenytoin is one causative agent)
- Discontinue the medication.
- NSAIDs,antimalarials can be temporarily used if constitutional,musculoskeletal symptoms do not clear rapidly.
- Glucocorticoids are infrequently required but can induce quick resolution of serositis.
SJS & TEN = mucosa involvement = mouth
Steven Johnson
is the less severe condition, characterized by
-> prodrome of malaise and fever
--> rapid onset erythematous/purpuric macules & plaques
----> skin lesions progress to epidermal necrosis and sloughing (< 10% body surface)
+ Mucosal membranes are affected in 92-100%
Toxic epidermal necrolysis (TEN),
-> prodrome of malaise and fever (temps higher than SJS, often exceed 39C)
-> 50% begin with diffuse erythema
--> skin lesions of widely distributed erythematous macules & patches, +skin pain may be prominent
---> full-thickness epidermal necrosis leading to sloughing (> 30% body surface)
+++ Mucous membranes involved in nearly 100%
thats all i could get from UpToDate...
so now, i'm guessing its drug sensitivity rash from phenytoin - oral CS...or the supportive tx -topical emollients (because of the scratching...do emollients help)?
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