Tox & Dermatology - Dr. Kopec

• Warfarin can cause two dermatologic syndromes: Warfarin Skin Necrosis (thrombotic) and Purple Toe Syndrome (embolic)

• Cutaneous Anthrax starts as a small, painless papule that transitions to a vesicle then necrotic ulcer with surrounding edema. It is most common on the head, neck, forearms and hands.
• Blistering Agents are sulfur mustard and lewisite. Sulfur mustard has no pain initially while lewisite there is immediate pain. 
  

• Chronic arsenic toxicity is associated with hyperkeratosis, skin pigmentation changes, Blackfoot's disease, lung, bladder and skin cancer. 
• Mee's line can be seen with arsenic, thallium, heavy metals, renal failure, chemotherapy and sepsis. 
• Inorganic mercury has been associated with a skin finding called Pink's disease or acrodynia. 
• Basophillic stipling and Burton's lines can be seen with lead toxicity. 
• The most common cause is allergic dermatitis is nickel. 
• Levamisole has been a known contaminant of cocaine causing skin necrosis. 
• To make the diagnosis of DRESS there must be: rash, fever, and end organ dysfunction.
• To differentiate between carotenemia vs jaundice, carotenemia can be wiped off with an alcohol wipe and it does not involve the sclera. 

• Red man syndrome is most commonly seen with vancomycin and rifampin. 

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