DRUG-INDUCED DERMATITIS

Clinical Manifestations
  • Patients show a history of medication.
  • There is an incubation period of 20-40 days.
  • If the medication is taken frequently, the incubation period shortens to as little as two hours.
  • The shape of the rash is varied.
  • The color is bright.
  • The involved area is vast and often symmetric.
  • Itching
  • Burning Heat
  • Usually accompanied by general symptoms.
  • The course is usually short if the patient ceases the dermatitis-inducing drug or receives proper treatment.
  • Urticaria-like type:
    Urticaria of various sizes over large areas
    Redder than common urticaria
    Itching with stabbing pain and tenderness
  • Scarlet fever or measle-like type:
    Extensive bright red macular , papular and maculopapular eruptions
    They can be millet to soy bean sized and spread over the skin symmetrically
    Itching
    No general symptoms (this is the main differentiation between measles or scarlet fever)
  • Erythema multiform-like type:
    The rash is in the form of edematous purple maculae
    The size ranges from a soybean to a coin
    The center is darker with possible vesicles
    It occurs symmetrically on the torso and limbs
    It sometimes involves the mouth, lips, eyes and pudendum
    Erosion
    Exudation
    Itching
    Fever
    Arthralgia
    Abdominal pain
  • Fixed erythematous type:
    This is a very common type
    Edematous, bright red, or purple, round or oval shaped maculae
    The center may have some vesicles
    Affects the eyes, anus, glans penis, and areas around the mouth where mucous membranes meet
    May be found on the torso and limbs
    Generally disappears within ten days unless there is ulceration on the pudendum
    Itching
    Long-lasting pigmentation will be left after recovery
    When the same drug is taken, the rash will appear in the same places
  • Purpuric type:
    Various sized echymoses or petechiae
    It feels flat or slightly raised
    In mild cases it is mostly on the legs
    In severe cases, it can involve the whole body
  • Exfoliative dermatitis type:
    This is severe with an incubation period of over twenty days
    The onset is often abrupt
    Measle-like and papular eruptions appear first then merge into a general diffuse rash
    The hands and feet may have edema and erosion, followed by repeated scaling and possibly by exfoliation of the hair and nails
    General itching and burning
    Aversion to Cold
    Nausea and vomiting
    Generally lasts over a month
  • Epidermolytic, big-vesicle-like type:
    This is the most severe type
    The onset is abrupt
    Continuous fever
    Bright red or purple maculae soon covering the whole body
    The lesions the take on folds, followed by loose purple vesicles, which are liable to ulcerate
    If there is concurrent infection, hematosepsis often results
    It is usually followed by exfoliation of mucous membranes of the mouth, trachea and esophagus with Spleen and Liver damage
Treatment Principle
Herb Formulas
Points
Clinical Manifestations
  • Intolerance of Cold
  • Abdominal fullness and distention
  • Constipation
  • Cannot purge easily due to lack of Qi
  • Hypochondriac pain
  • Fever
  • Cold extremities
  • Hernia
  • Abdominal pain
  • T:  Normal
  • P:  Rolling and forceful or Tight and wiry
Treatment Principle
  • Warm and Purge Cold retention
Herb Formulas
Points
Clinical Manifestations
  • Erythema
  • Papules
  • Wheals
  • Itching
  • Mild fever
  • Thirst
  • T: Red
  • C: Yellow
  • P: Floating and rapid
Treatment Principle
  • Expel Wind
  • Clear Heat and toxins
  • Stop itching
Herb Formulas
Points
Clinical Manifestations
  • High fever
  • Confusion of mind
  • Delirium
  • Mania
  • Dark yellow urine
  • Excessive skin rashes all over body
  • Hemorrhage:
    Hematemesis
    Hemoptysis
    Epistaxis
    Hemafecia
    Hematuria
  • T: Deep red, dry or Purple red
    C: None
    P: Rapid or Thready and rapid or Thready and feeble
Treatment Principle
  • Cool the Blood
  • Dispel Heat and Toxins from the Xue Stage
  • Promote Blood Circulation
Herb Formulas
Points
Clinical Manifestations
  • Dermatitis
  • Severe, splitting headaches with dizziness
  • Sudden tinnitus or
  • Sudden deafness
  • Flushed face
  • Red, swollen, painful eyes
  • Irascibility with violent angry outbursts
  • Dry mouth
  • Bitter taste in mouth
  • Thirst
  • Vomiting sour or bitter liquid
  • Insomnia
  • Restlessness
  • Constipation or dry stools
  • Maybe rib pain
  • In severe cases:
    Mania
    Hemoptysis
    Hematemesis
    Epistaxis
  • Liver Fire Attacks the Lungs:
    Hemoptysis
    Rib pain which is severe when coughing
  • Liver Fire Attacks the Stomach:
    Hematemesis
  • T: Red tip and edges
  • C: Thick, yellow, dry and rough
  • P: Wiry, Excess and rapid
Treatment Principle
  • Clear the Liver
  • Purge Fire
Herb Formulas
Points
Clinical Manifestations
  • This occurs in the late stages and convalescence
  • No high fever
  • The skin lesions haver healed and become dry with scales
  • Pale complexion
  • Lassitude
  • Hypodynamia
  • T: Pale
  • C: Thin, white and scanty
  • P: Thready and rapid
Treatment Principle
  • Nourish Yin and Blood
  • Tonify Qi
  • Move Qi
  • Expel Wind
Herb Formulas
Points
Clinical Manifestations
  • Erythrinae
  • Swelling
  • Exudation
  • Erosion
  • Itching
  • T: Red
  • C: Thin and white or Thin and yellow
  • P: Floating and rapid
Treatment Principle
  • Clear Heat and toxins
  • Remove Wind
  • Expel Dampness
Herb Formulas
Points
Clinical Manifestations
  • General diffuse skin flushing
  • Skin denudation or
  • Large violet red maculae
  • Large vesicles
  • Erosion
  • Concurrent infection
  • Coma due to a high fever
  • Restlessness
  • Thirst
  • T: Dark red
  • C: Yellow and dry
  • P: Full and rapid
Treatment Principle
  • Clear Heat and toxins
  • Cool Blood Heat
Herb Formulas
Points