Let's take a look at the first group first.
The first example of a non-immune mediated
acute cutaneous drug reaction I'd like
to go over is idiosyncratic.
These are basically just inherited enzyme
deficiencies that lead to potentially
cutaneous reactions. This is
a good example of
the inherited enzyme deficiency known as
alcohol dehydrogenase deficiency
that is common to folks of Asian descent.
Basically, a patient who consumes
alcohol and lacks this enzyme will
lead to an accumulation of
aldehyde, which manifests with
this alcohol flush reaction
that we're seeing in the far right here.
The next non-immune mediated
type of acute cutaneous drug reaction
is the cumulative type.
This is basically a dose-dependent
phenomenon, where as
long as you continue to take a medication,
there are manifestations
that will emerge in the skin. And the
classic example of this is amiodarone.
When you consume amiodarone for months
to years, you can develop this slat
gray pigmentation in the skin. Then there's
the photosensitivity type.
This is basically a combination between
a drug that you ingest
and exposure to sunlight. And a good
example is shown here with
porphyria cutanea tarda. Folks who have
porphyria cutanea tarda, if
they ingest, say, iron,
if they're then exposed to
sunlight, can develop this
florid reaction here on the hands,
with some bullous formation,
vesicles, etc. And lastly, irritant type.
An irritant is a non-immune
It's basically caused by topically
that are simply somewhat toxic to
the skin or irritating to the skin.
A good example of that would be someone
who applies 5-fluorouracil cream to the hands.