Life-Threatening Skin Rashes (cont.)
What Are Causes of Life-Threatening Skin Rashes?
Pemphigus vulgaris is an autoimmune skin disease that occurs when the body's immune system is misdirected and produces antibodies directed at a protein vital to the connection of epidermal cells. Toxic epidermal necrolysis and DRESS syndrome are hypersensitivity reactions, most often to drugs. Meningococcemia, Rocky Mountain spotted fever, and necrotizing fasciitis are due to an infection.
- Pemphigus vulgaris (PV)
- PV is a disorder of the immune system (an autoimmune disorder). As in all autoimmune disorders, the body's natural immune system mistakenly identifies proteins within the skin as foreign by producing antibodies to attack the foreign intruder.
- In PV, the target of these antibodies is a protein named desmoglein 3, which is part of a structure called a desmosome. Desmosomes are responsible for holding epidermal cells together.
- Certain medications have been linked with the development of PV, including D-penicillamine (Cuprimine, Depen), captopril (Capoten), enalapril (Vasotec), penicillin, interleukin 2, nifedipine (Adalat CC, Procardia, Procardia XL), and rifampicin (Rifadin).
- Toxic epidermal necrolysis (TEN)
- The exact cause of TEN is unknown, but it is thought to be a severe form of allergic reaction to certain medications or infections.
- Antibiotics, typically sulfa-containing and penicillin-containing antibiotics, and medications given for seizures (phenytoin [Dilantin, Dilantin Infatabs, Dilantin Kapseals, Dilantin-125, Phenytek, Phenytoin Sodium, Prompt], phenobarbital [Solfoton], carbamazepine [Carbatrol, Equetro, Tegretol, Tegretol XR], and lamotrigine [Lamictal]) have been linked to TEN, as have the nonsteroidal anti-inflammatory drugs.
- Other possible causes include viral infections with hepatitis, herpes simplex, Epstein-Barr, cytomegalovirus, and influenza viruses; bacterial infections with streptococcal-type and tuberculous bacteria; vaccination, particularly with the smallpox vaccination; and cancers.
- Medications used to treat HIV, which include the protease inhibitors (PI) (atazanavir), the nucleoside reverse transcriptase inhibitors (NRTI) (efavirenz [Sustiva]), and the nonnucleoside reverse transcriptase inhibitors (NNRTI) (abacavir [Ziagen], nevirapine [Viramune]) have been associated with TEN.
- DRESS syndrome is an acronym for drug rash with eosinophilia and systemic symptoms.
- This is a severe form of drug eruption that can begin two to six weeks after starting to take the offending drug. Frequent causes are anticonvulsants, namely phenytoin, phenobarbitone, carbamazepine, and lamotrigine. Other drugs incriminated include dapsone, sulphonamides, allopurinol, minocycline, terbina?ne, azathioprine, captopril, nevirapine, abacavir, and sulfasalazine.
- Toxic shock syndrome (TSS)
- TSS is caused by an underlying infection with certain strains of Staphylococcus bacteria.
- Bacterial toxins are released into the bloodstream, producing diffuse organ damage.
- TSS became a public-health issue in the 1970s with the introduction of super-absorbent tampons. These tampons acted as a foreign body to support bacterial growth of the Staphylococcus bacteria.
- Other infections that may lead to TSS include superficial skin infections, surgical wound infections, infections after delivering a baby, or infected nasal packings after nasal surgery or nosebleeds.
- Meningococcemia is a blood infection (septicemia) caused by Neisseria meningitis. This infection is most common in young adults and may also affect the membrane surrounding the brain and spinal cord. It is acquired through coughing, sneezing, or contaminated surfaces. Vaccination can prevent meningococcemia.
- Rocky Mountain spotted fever is an infection caused by a small microorganism called a Rickettsia and is transmitted to humans through the bite of a hard shell tick.
- Necrotizing fasciitis is a bacterial infection most often localized to an extremity and is due to the extremely rapid penetration of the infection into the deeper tissues and the bloodstream.
Medically Reviewed by a Doctor on 5/20/2016
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