Laura Doerfler, MD

Review the PDF of the fact sheet on drug reactions with board-relevant, easy-to-review material. This month's fact sheet will review common drug reactions including their clinical presentation, associated signs, symptoms and laboratory abnormalities, time of onset, implicated drugs, pathology, and treatment and mortality.

Practice Questions

1. RegiSCAR is a scoring method used for what drug reaction?

a. RegiSCAR is a diagnostic scoring method for DRESS/DIHS
b. RegiSCAR is a diagnostic scoring method for FDE
c. RegiSCAR is a diagnostic scoring method for SJS
d. RegiSCAR predicts mortality rate for AGEP
e. RegiSCAR predicts mortality rate for SJS

2. DRESS/DIHS is associated with what mortality rate?

a. 0%
b. 1%–5%
c. 5%–10%
d. 5%–30%
e. 10%–40%

3. Unlike other drug eruptions that typically develop 1 to 2 weeks after drug initiation, which drug eruption has a relatively late onset, often 3 weeks after drug initiation?

a. AGEP
b. DRESS/DIHS
c. exanthematous/morbilliform drug eruption
d. FDE
e. SJS

4. A patient develops a morbilliform eruption 14 days after starting an anticonvulsant. What additional finding(s) make DRESS/DIHS more likely than a common morbilliform drug rash?

a. hypocalcemia
b. lymphadenopathy
c. prominent facial edema
d. A and C
e. B and C

5. Which drug is commonly implicated in the nonpigmenting variant of FDE?

a. barbiturates
b. carbamazepine
c. NSAIDs
d. pseudoephedrine
e. sulfonamides

Answers to practice questions provided on next page

Practice Question Answers

1. RegiSCAR is a scoring method used for what drug reaction?

a. RegiSCAR is a diagnostic scoring method for DRESS/DIHS
b. RegiSCAR is a diagnostic scoring method for FDE
c. RegiSCAR is a diagnostic scoring method for SJS
d. RegiSCAR predicts mortality rate for AGEP
e. RegiSCAR predicts mortality rate for SJS

2. DRESS/DIHS is associated with what mortality rate?

a. 0%
b. 1%–5%
c. 5%–10%
d. 5%–30%
e. 10%–40%

3. Unlike other drug eruptions that typically develop 1 to 2 weeks after drug initiation, which drug eruption has a relatively late onset, often 3 weeks after drug initiation?

a. AGEP
b. DRESS/DIHS
c. exanthematous/morbilliform drug eruption
d. FDE
e. SJS

4. A patient develops a morbilliform eruption 14 days after starting an anticonvulsant. What additional finding(s) make DRESS/DIHS more likely than a common morbilliform drug rash?

a. hypocalcemia
b. lymphadenopath
c. prominent facial edema
d. A and C
e. B and C

5. Which drug is commonly implicated in the nonpigmenting variant of FDE?

a. barbiturates
b. carbamazepine
c. NSAIDs
d. pseudoephedrine
e. sulfonamides

Article PDF

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Dr. Doerfler is third-year resident from the Department of Dermatology, Wake Forest University, Winston-Salem, North Carolina. Dr. Huang is Assistant Professor and Associate Program Director of Dermatology, Wake Forest University School of Medicine.

The authors report no conflict of interest.

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Practice Questions

1. RegiSCAR is a scoring method used for what drug reaction?

2. DRESS/DIHS is associated with what mortality rate?

a. 0%
b. 1%–5%
c. 5%–10%
d. 5%–30%
e. 10%–40%

3. Unlike other drug eruptions that typically develop 1 to 2 weeks after drug initiation, which drug eruption has a relatively late onset, often 3 weeks after drug initiation?

a. AGEP
b. DRESS/DIHS
c. exanthematous/morbilliform drug eruption
d. FDE
e. SJS

4. A patient develops a morbilliform eruption 14 days after starting an anticonvulsant. What additional finding(s) make DRESS/DIHS more likely than a common morbilliform drug rash?

a. hypocalcemia
b. lymphadenopathy
c. prominent facial edema
d. A and C
e. B and C

5. Which drug is commonly implicated in the nonpigmenting variant of FDE?

a. barbiturates
b. carbamazepine
c. NSAIDs
d. pseudoephedrine
e. sulfonamides

Answers to practice questions provided on next page

Practice Question Answers

1. RegiSCAR is a scoring method used for what drug reaction?

2. DRESS/DIHS is associated with what mortality rate?

a. 0%
b. 1%–5%
c. 5%–10%
d. 5%–30%
e. 10%–40%

3. Unlike other drug eruptions that typically develop 1 to 2 weeks after drug initiation, which drug eruption has a relatively late onset, often 3 weeks after drug initiation?

a. AGEP
b. DRESS/DIHS
c. exanthematous/morbilliform drug eruption
d. FDE
e. SJS

4. A patient develops a morbilliform eruption 14 days after starting an anticonvulsant. What additional finding(s) make DRESS/DIHS more likely than a common morbilliform drug rash?

a. hypocalcemia
b. lymphadenopath
c. prominent facial edema
d. A and C
e. B and C

5. Which drug is commonly implicated in the nonpigmenting variant of FDE?

a. barbiturates
b. carbamazepine
c. NSAIDs
d. pseudoephedrine
e. sulfonamides

Practice Questions

1. RegiSCAR is a scoring method used for what drug reaction?

2. DRESS/DIHS is associated with what mortality rate?

a. 0%
b. 1%–5%
c. 5%–10%
d. 5%–30%
e. 10%–40%

3. Unlike other drug eruptions that typically develop 1 to 2 weeks after drug initiation, which drug eruption has a relatively late onset, often 3 weeks after drug initiation?

a. AGEP
b. DRESS/DIHS
c. exanthematous/morbilliform drug eruption
d. FDE
e. SJS

4. A patient develops a morbilliform eruption 14 days after starting an anticonvulsant. What additional finding(s) make DRESS/DIHS more likely than a common morbilliform drug rash?

a. hypocalcemia
b. lymphadenopathy
c. prominent facial edema
d. A and C
e. B and C

5. Which drug is commonly implicated in the nonpigmenting variant of FDE?

a. barbiturates
b. carbamazepine
c. NSAIDs
d. pseudoephedrine
e. sulfonamides

Answers to practice questions provided on next page

Practice Question Answers

1. RegiSCAR is a scoring method used for what drug reaction?

2. DRESS/DIHS is associated with what mortality rate?

a. 0%
b. 1%–5%
c. 5%–10%
d. 5%–30%
e. 10%–40%

3. Unlike other drug eruptions that typically develop 1 to 2 weeks after drug initiation, which drug eruption has a relatively late onset, often 3 weeks after drug initiation?

a. AGEP
b. DRESS/DIHS
c. exanthematous/morbilliform drug eruption
d. FDE
e. SJS

4. A patient develops a morbilliform eruption 14 days after starting an anticonvulsant. What additional finding(s) make DRESS/DIHS more likely than a common morbilliform drug rash?

a. hypocalcemia
b. lymphadenopath
c. prominent facial edema
d. A and C
e. B and C

5. Which drug is commonly implicated in the nonpigmenting variant of FDE?

a. barbiturates
b. carbamazepine
c. NSAIDs
d. pseudoephedrine
e. sulfonamides

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Allergic Contact Dermatitis, Part 4

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with board-relevant, easy-to-review material. This month’s fact sheet will be the last in an ongoing series focusing on common allergens seen in practice and represents a high-yield topic for board examination purposes.

Practice Questions

1. The most common allergen of hand dermatitis in hairdressers can cross-react with which of the following allergens?

a. benzocaine
b. para-aminobenzoic acid
c. procaine
d. sulfanomides
e. all of the above

2. Patients with a documented allergy to quaternium-15 should avoid all of the following ingredients except:

a. bronopol
b. diazolidinyl urea
c. DMDM hydantoin
d. imidazolidinyl urea
e. paraben mix

3. Which of the following is a screening agent for hydrocortisone allergy?

a. budesonide
b. clobetasol
c. desoximetasone
d. paraben mix
e. tixocortol pivalate

4. This allergen often is found in black synthetic henna tattoos:

a. paraben mix
b. potassium dichromate
c. PPD
d. quaternium-15
e. thimerosol

5. A patient with a documented allergy to paraben mix also should avoid the following agent:

a. bronopol
b. diazolidinyl urea
c. DMDM hydantoin
d. PPD
e. thiuram mix

Practice Question Answers

1. The most common allergen of hand dermatitis in hairdressers can cross-react with which of the following allergens?

a. benzocaine
b. para-aminobenzoic acid
c. procaine
d. sulfanomides
e. all of the above

2. Patients with a documented allergy to quaternium-15 should avoid all of the following ingredients except:

a. bronopol
b. diazolidinyl urea
c. DMDM hydantoin
d. imidazolidinyl urea
e. paraben mix

3. Which of the following is a screening agent for hydrocortisone allergy?

a. budesonide
b. clobetasol
c. desoximetasone
d. paraben mix
e. tixocortol pivalate

4. This allergen often is found in black synthetic henna tattoos:

a. paraben mix
b. potassium dichromate
c. PPD
d. quaternium-15
e. thimerosol

5. A patient with a documented allergy to paraben mix also should avoid the following agent:

a. bronopol
b. diazolidinyl urea
c. DMDM hydantoin
d. PPD
e. thiuram mix

Article PDF

Author and Disclosure Information

Dr. Doerfler is from the Department of Dermatology, Wake Forest University. Dr. Huang is Assistant Professor and Associate Program Director of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.

The authors report no conflict of interest.

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Practice Questions

1. The most common allergen of hand dermatitis in hairdressers can cross-react with which of the following allergens?

a. benzocaine
b. para-aminobenzoic acid
c. procaine
d. sulfanomides
e. all of the above

2. Patients with a documented allergy to quaternium-15 should avoid all of the following ingredients except:

a. bronopol
b. diazolidinyl urea
c. DMDM hydantoin
d. imidazolidinyl urea
e. paraben mix

3. Which of the following is a screening agent for hydrocortisone allergy?

a. budesonide
b. clobetasol
c. desoximetasone
d. paraben mix
e. tixocortol pivalate

4. This allergen often is found in black synthetic henna tattoos:

a. paraben mix
b. potassium dichromate
c. PPD
d. quaternium-15
e. thimerosol

5. A patient with a documented allergy to paraben mix also should avoid the following agent:

a. bronopol
b. diazolidinyl urea
c. DMDM hydantoin
d. PPD
e. thiuram mix

Practice Question Answers

1. The most common allergen of hand dermatitis in hairdressers can cross-react with which of the following allergens?

a. benzocaine
b. para-aminobenzoic acid
c. procaine
d. sulfanomides
e. all of the above

2. Patients with a documented allergy to quaternium-15 should avoid all of the following ingredients except:

a. bronopol
b. diazolidinyl urea
c. DMDM hydantoin
d. imidazolidinyl urea
e. paraben mix

3. Which of the following is a screening agent for hydrocortisone allergy?

a. budesonide
b. clobetasol
c. desoximetasone
d. paraben mix
e. tixocortol pivalate

4. This allergen often is found in black synthetic henna tattoos:

a. paraben mix
b. potassium dichromate
c. PPD
d. quaternium-15
e. thimerosol

5. A patient with a documented allergy to paraben mix also should avoid the following agent:

a. bronopol
b. diazolidinyl urea
c. DMDM hydantoin
d. PPD
e. thiuram mix

Practice Questions

1. The most common allergen of hand dermatitis in hairdressers can cross-react with which of the following allergens?

a. benzocaine
b. para-aminobenzoic acid
c. procaine
d. sulfanomides
e. all of the above

2. Patients with a documented allergy to quaternium-15 should avoid all of the following ingredients except:

a. bronopol
b. diazolidinyl urea
c. DMDM hydantoin
d. imidazolidinyl urea
e. paraben mix

3. Which of the following is a screening agent for hydrocortisone allergy?

a. budesonide
b. clobetasol
c. desoximetasone
d. paraben mix
e. tixocortol pivalate

4. This allergen often is found in black synthetic henna tattoos:

a. paraben mix
b. potassium dichromate
c. PPD
d. quaternium-15
e. thimerosol

5. A patient with a documented allergy to paraben mix also should avoid the following agent:

a. bronopol
b. diazolidinyl urea
c. DMDM hydantoin
d. PPD
e. thiuram mix

Practice Question Answers

1. The most common allergen of hand dermatitis in hairdressers can cross-react with which of the following allergens?

a. benzocaine
b. para-aminobenzoic acid
c. procaine
d. sulfanomides
e. all of the above

2. Patients with a documented allergy to quaternium-15 should avoid all of the following ingredients except:

a. bronopol
b. diazolidinyl urea
c. DMDM hydantoin
d. imidazolidinyl urea
e. paraben mix

3. Which of the following is a screening agent for hydrocortisone allergy?

a. budesonide
b. clobetasol
c. desoximetasone
d. paraben mix
e. tixocortol pivalate

4. This allergen often is found in black synthetic henna tattoos:

a. paraben mix
b. potassium dichromate
c. PPD
d. quaternium-15
e. thimerosol

5. A patient with a documented allergy to paraben mix also should avoid the following agent:

a. bronopol
b. diazolidinyl urea
c. DMDM hydantoin
d. PPD
e. thiuram mix

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