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Medicinal Exanthema

erythema, preparations, urticaria, erythematous, pigmentations and idiosyncrasy

MEDICINAL EXANTHEMA Medicinal exanthemata occur in specially disposed individuals in whom medicines produce a toxic effect.

Clinical Picture.—The forms of niedicinal exanthema, its ap pearance and character, are exceedingly variable. They are distin guished above all by considerable polymorphisn), so that in one and the same subject we meet with erythematous, urtiearial, Inemorrhagic and desquamative conditions and vesicular formations, sometimes inter spemed by pigmentations and proliferations of all kinds. It is impossible to establish a typical pathological picture for the reason that one medicine inay produce different manifestations in different organisms.

Drug rashes may be caused by external and internal medication. It presupposes a special condition which is designated as idiosyncrasy, that is, a very pronounced susceptibility for a certain substance. Only minimal quantities of such substances are required to exert under certain circumstanceS a maximum effect. Very often we meet with eases where some chemical substance exercises a cumulative effect upon the body, i.e., that a particular chemical substance is borne very- well in the begin ning, but that after large quantities have been absorbed, the idiosyn crasy asserts itself. On the other hand it has been observed that acquired idiosyncrasy asserts itself only with certain metabolic disturbances, intestinal disorders, etc., and that only under such circumstances the idiosyncrasy is gradually acquired. Jadassohn has called attention to the phenomenon of immunization: certain parts of the skin which formerly became affected, remain immune on a repeated eruption of medicinal exanthema, so that a partial immunization of single parts of the skin may occur.

In early childhood drug rashes do not occur very frequently in view of the fact that at that period medicines are not frequently prescribed. To facilitate a general survey, I append a brief enumeration of the most frequently used medicines in infancy and their by-effects.

1. Benzoic acid and benzoinate of soda (erythema).

2. Boric acid (erythematous eruptions).

3. Antipyrin, antifebrin, phenacetin, salipyrin (erythema, urticaria, haemorrhages, wheals, pigmentations).

4. Atropin (scarlatinoid erythema).

5. Arsenic (herpes, urticaria, pigmentations).

6. Tannic acid (urticarial, erythematous eruptions).

7. Bromide preparations (bromide acne, furunculid Chrysarobin (serious erythematous and eczematous affections).

9. Quinine preparations (erythema).

10. Chloral hydrate (purpura, urticaria).

11. Chloroform (erythenut, eczema).

12. Formalin (eczema, nail affections).

13. locloform (severe dermatitis of all kinds, erythema).

14. Iodine (nodular eruptions).

15. Opium and morphine, codeine (erythema, urticaria).

16. Phenol (inflammatory dermatitis, erythema).

17. Mercury preparations (erythema eczema).

1S. Pilocarpin and syrup Jaborandi (sutlamina).

19. Salicylic preparations (erythema, purpura-like affections).

20. Santonin (urticaria).

21. Sulfonal (measle and scarlatina-like erythema).

22. Tar preparations (folliculitmeezematous dermatitis).

Differential diagnosis is not always easy. Sometimes the diagnosis becomes possible only from the frequency of the relapses. Generally speaking, every pathologieal picture which is remarkable for its polymorphism should arouse suspicion as to a possible medicinal exanthema.

The prognosis is benign, as soon as the cause of the drug rash has been establi.shed.

treatment consists in the removal of the cause, in the promotion of diuresis and clearing out the intestine. The local therapy depends upon the stage of the disease, so that it must be anti urticarial, anti-eczematous or anti-erythernatous, as the case may be.