Switch to Dark theme

30. Red skin

From Volume 44, Issue 4, April 2017 | Page 363

Authors

Dimitrios Malamos

DDS, MSc, PhD, DipOM

Oral Medicine Clinic, National Organization for the Provision of Health Services (IKA), Athens, Greece

Articles by Dimitrios Malamos

Crispian Scully

CBE, DSc, DChD, DMed (HC), Dhc(multi), MD, PhD, PhD (HC), FMedSci, MDS, MRCS, BSc, FDS RCS, FDS RCPS, FFD RCSI, FDS RCSEd, FRCPath, FHEA

Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK

Articles by Crispian Scully

Article

Dimitrios Malamos
Crispian Scully

A 56-year-old woman presented for evaluation of a skin rash of 5 hours duration. This rash consisted of discrete red maculo-papules (Figure 1) which started initially from her face and neck and spread within 2 hours onto her abdomen and arms and legs. This skin rash was pruritic and associated with nausea, anxiety and some breathing difficulties. The patient suffered only from psoriasis and mild diabetes controlled by diet, and shingles two months previously. Penicillin was the only drug taken by the patient, over the previous 4 days, for treatment of a periapical infection. No history of food, plants, cosmetic or animal allergies was recorded.

Figure 1. Palmar red rash.

Q1. What is the possible cause of this skin rash?

  • Contact dermatitis;
  • Chicken pox;
  • Drug reaction;
  • Psoriasis;
  • Insect bites.

    • A1. The answer to what is the possible cause of this skin rash?

    This skin rash was an allergic drug reaction to penicillin. This is a very common side-effect and appears within 5–6 days of drug uptake and ranges from mild to life-threatening. This is a body reaction to histamine release and can be either a mild reaction, including an acute itching rash, abdominal upset and nausea, as seen in this patient, or a severe form causes breathing problems, facial or tongue oedema and confusion and collapse (anaphylaxis). The direct contact of the skin with various allergens or irritants from plants or foods can cause a similar red rash known as contact dermatitis. However, this dermatitis differs in that it is characteristically restricted only to the areas of allergen exposure, and its maculo-papular lesions contain clear fluid (vesicles or small bullae). A vesicular exanthema is also often seen in patients with chickenpox or with insect bites but their clinical picture and symptomatology is different.

    The absence of hyperkeratotic white scales covering the skin rash allows the exclusion of psoriasis from the diagnosis.

    Q2. Which of the indications below suggest a drug reaction?

  • When the oral lesion appears within 1–2 weeks of drug intake;
  • When the oral lesion disappears within a few hours or days of the suspected drug withdrawal;
  • When the oral lesion is associated with taste changes;
  • When the oral lesion disappears shortly after the use of steroids.

    • A2. The answer to which of the indications below suggest a drug reaction?

    Dentists should always consider an oral lesion as a drug reaction as long as the lesion appeared at the same time as the drug intake and disappeared shortly after its withdrawal.