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Back to Addiction support. If you need treatment for drug addiction, you're entitled to NHS care in the same way as anyone else who has a health problem. With the right help and support, it's possible for you to get drug free and stay that way. A GP is a good place to start. They can discuss your problems with you and get you into treatment. They may offer you treatment at the practice or refer you to your local drug service. If you're not comfortable talking to a GP, you can approach your local drug treatment service yourself. Visit the Frank website to find support near you. If you're having trouble finding the right sort of help, call the Frank drugs helpline on They can talk you through all your options. As well as the NHS, there are charities and private drug and alcohol treatment organisations that can help you. Visit the Adfam website to see a list of useful organisations. Private drug treatment can be very expensive, but sometimes people get referrals through their local NHS. At your first appointment for drug treatment, staff will ask you about your drug use. They'll also ask about your work, family and housing situation. Staff will talk you through all of your treatment options and agree a treatment plan with you. They can tell you about local support groups for drug users and their families or carers. You'll also be given a keyworker, who will support you throughout your treatment. Your treatment will depend on your personal circumstances and what you're addicted to. Your keyworker will work with you to plan the right treatment for you. Your treatment plan may include a number of different treatments and strategies. Talking therapies, such as CBT , help you to see how your thoughts and feelings affect your behaviour. If you're dependent on heroin or another opioid, you may be offered a substitute drugs, such as methadone or buprenorphine. This means you can get on with your treatment without having to worry about withdrawing or buying street drugs. This is for people who want to stop taking opioids like heroin completely. It helps you to cope with the withdrawal symptoms. Your keyworker can tell you where your nearest group is. Staff at your local drug service will help reduce the risks associated with your drug-taking. You may have your treatment while living at home or as a hospital inpatient. If your drug-related problems are severe or complicated, you may be referred to a residential rehabilitation service. For more information about residential rehabilitation, or to find a rehab near you, visit Rehab-Online. Page last reviewed: 13 February Next review due: 13 February Drug addiction: getting help. Where to get help for drugs A GP is a good place to start. Charity and private drugs treatment As well as the NHS, there are charities and private drug and alcohol treatment organisations that can help you. Your first appointment At your first appointment for drug treatment, staff will ask you about your drug use. You may be asked to provide a sample of urine or saliva. What drug treatment involves Your treatment will depend on your personal circumstances and what you're addicted to. Talking therapies Talking therapies, such as CBT , help you to see how your thoughts and feelings affect your behaviour. Treatment with medicines If you're dependent on heroin or another opioid, you may be offered a substitute drugs, such as methadone or buprenorphine. Detoxification detox This is for people who want to stop taking opioids like heroin completely. Reducing harm Staff at your local drug service will help reduce the risks associated with your drug-taking. Where you'll have your treatment You may have your treatment while living at home or as a hospital inpatient.

Drug addiction: getting help

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Official websites use. Share sensitive information only on official, secure websites. Adverse reactions to drugs are not frequent in childhood. Cutaneous reactions are the most frequent in this age group. Mild cutaneous reactions are immediate or delayed adverse reactions that do not seriously compromise the clinical condition of children. The patients usually early improve and recover the state of health. Although it is difficult to define the prevalence accurately, we could affirm that the rate adverse reaction to drugs are often over estimated by both the families and the physicians. Therefore, children may be prone to loss of school days and inappropriate or sub-optimal treatments. However, the identification of a true adverse reaction to drugs allows adequate treatment and alert to further exposure to harmful drugs. Keywords: drug hypersensitivity reactions, children, skin test, specific IgE, drug provocation test, exanthema, urticaria. Cutaneous adverse drug reaction CADR may be defined as an undesirable manifestation of the skin resulting from administration of a drug. It could be estimated that 2. Reactions are more frequently reported following intake of antimicrobials, neurology drugs, and dermatological agents 3. CADRs can be divided into different classes based on pathogenesis and clinical morphology. On the basis of pathogenesis, they are divided into 2 categories. Such reactions have been categorized as immunologic hypersensitivity allergic reactions, pseudo-allergic, and idiosyncratic 5 , 7. At variance from adults, type B reactions are more common in children. CADRs can also be identified on the basis of the clinical presentation. Distribution, morphology, configuration, and progression of the lesions should be adequately described. At least 29 mild to rarely severe clinical presentation of cutaneous drug reactions have been identified 8 - We will discuss only mild cutaneous reactions in childhood Table 1. The most common type of EDEs is maculopapular rash MPR that is characterized by erythematous macules evolving in papules from 1 to 5 mm in diameter and may coalesce in plaques. MPR involves face, neck, or upper trunk and tipically spreads bilaterally and symmetrically toward the limbs. MPR could be accompanied by pruritus and mild fever MPR is self-limiting and resolves within days after stopping the drug. With resolution, lesions may become brownish and desquamation may occur. EDEs are usually considered delayed-type hypersensitivity reactions, although evidence of such a mechanism is rare. There is a distinguishing timing of occurrence of lesions At the first drug exposure, lesions appear after a sensitization phase, days after the start of therapy and sometimes after drug discontinuation 8. In previously sensitized patients, skin lesions develop following re-exposure to the same drug in 6 hours to days. The most common implicated drugs include beta-lactams, sulfonamides, and antiepileptic medications This frequency increases substantially during a viral infection. Children who are infected with the Epstein-Barr virus are at increased risk of rash In EDE, patch test and provocation test should be used to identify the culprit drug 20 , The management of EDE is supportive. Pruritus can be treated with topical steroids, emollients, oral antihistamines. Second generation H1 blockers are associated with fewer sedative effects when compared with first generation H1 blockers 22 , A post-inflammatory hypopigmentation or hyperpigmentation may follow which vanishes over months or years, and sun avoidance or protection should be advised The choice of suspending the offending drug must be made on individual basis. It is unclear whether continuation of a drug can lead to Steven-Johnson Syndrome Topical steroids and emollients are therapeutic options in children with eczematous reactions Wheal are characterized by central swelling surrounded by an erythematous area and pruritus rarely burning Each wheal resolves in 24 hours but new lesions may appear. Drug-induced urticaria is due to mediators, including histamine, and citokines released by activated mast-cells Mast-cells can be degranulated by an IgE-mediated mechanism or directly by the drug NSAIDs usually elicit a nonimmune mediated urticaria and should be cautiously administered in children with chronic urticaria since it may aggravate symptoms In acute urticaria, skin prick test should be used to identify the offending drug. Drug provocation test should be performed when it is appropriate 21 , 30 in a setting where personnel and emergency treatment is available Treatment includes discontinuation of the causative drug and administration of 2nd generation H1-antihistamines If there are sleeping problems caused by pruritus, sedative antihistamines could be used at night, but do not improve control of symptoms Oral corticosteroids in addition to antihistamines may be beneficial The problem arises when the causative drug cannot be halted and urticaria is not controlled by reliever medications. In these cases, probiotics that are mainly used in the prevention of infectious diseases 38 , 39 , seem to be promising in reducing symptoms FDEs begin as soon as 30 minutes-8 hours after drug intake and as long as 2 months after drug exposure 8 , Lesions are characterized by well-demarcated, solitary or multiple papules or plaques. Their colour varies from dusky red to violet. They can be intensely pruritic 8. Lesions resolve in days but hyperpigmentation can persist for years The sites of lesions include lips, trunk, legs, arms, and genitals. Genitals are affected particularly in adolescents. Most reactions occur in multiple sites 43 - Multiple lesions are rarely associated with systemic symptoms including malaise, high fever, nausea, and arthralgia 49 - In previously sensitized patients, a flare develops at the same site following re-exposure 8 , 53 to the offending drug within hours In the pediatric population, the most common drugs that cause FDEs are: antimicrobials amoxicillin, teicoplanin, vancomycin, co-trimoxazole , NSAIDs paracetamol, ibuprofen, nimesulide, naproxen, metamizol , barbiturates, sulphonamides The exact pathogenic mechanisms remain unknown. FDEs are probably underdiagnosed in primary care The gold standard for diagnosis of FDEs is re-challenge, depending on the severity of the initial reaction The cornerstone of the treatment is discontinuation of the causal drug that can worse the lesions 8. Management of FDE is supportive and is based on topical steroids. Drug-induced photosensitivity refers to the development of cutaneous disease due to the interaction between a given chemical agent and sunlight Exposure to either the chemical or the light alone is not enough to induce the disease. When photoactivation of the chemical occurs, one or more cutaneous manifestations may arise. Based on their pathogenesis, they can be classified as phototoxic or photoallergic drug eruptions, although in many cases it is not possible to determine whether a particular eruption is due to a phototoxic or photoallergic mechanism Drug-induced phototoxicity occurs when photoradiation interacts with a chemical within the skin to generate free radicals, which induces host cytotoxic effects. The site of the eruption coincides with sun-exposed areas of the skin. Phototoxic reactions are non-immunologic and dose dependant and often occur soon after initial ingestion of the drug. There are 3 general variations of phototoxic reactions The first is an intense and delayed erythema and edema that occurs 8 to 24 hours after exposure to sunlight. This reaction can involve hyperpigmentation and be a darker red than sunburn. Hydrochlorothiazide is an example of a trigger for this first type of phototoxic reaction. A second, more-immediate variation can occur within 30 minutes after light exposure and can last for a day or two. In this variant, erythema occurs without edema and is accompanied by local burning and pruritis. This more-immediate variation is often associated with doxycycline and the coal-tar derivatives such as anthracene and acridine. The third variant is associated with porphyrins and manifests as a rapid, transient, urticarial-like eruption that can be activated by room lighting. In contrast, photoallergic reactions occur after a period of sensitization and can reoccur with small doses of the offending drugs. The reactions may appear with papulovesicular eruption, pruritis, and eczematous dermatitis 1 to 14 days after exposure to sunlight. Photoallergic reactions should be differentiated from lupus, solar urticaria 61 - Phototesting and photopatch testing can be useful for achieving the diagnosis. The mainstay of management is prevention, including informing patients of the possibility of increased sun sensitivity and the use of sun protective measures. Moisturizes and emollients can be useful to treat the burning. In severe cases, topical antibiotic can be considered for vesicles and blisters. Oral antihistamines and topical corticosteroids can provide symptomatic relief of skin lesions due to photoallergic reactions 13 , Lymphadenopathy and eosinophilia may be present. They have claimed mostly associated with cefaclor therapy. The development of bacterial resistance to cefaclor has limited its utility in the treatment of pediatric infections For this reason, SSLRs might be less common now than in the past. Cross-reaction of cefaclor with other beta-lactam antibiotics is rare and, in general, other cephalosporins are well tolerated However, some physicians recommend that all beta-lactam antibiotics should be avoided in patients who have experienced cefaclor induced SSLR Other drugs that have been implicated include biological agents efalizumab, omalizumab, rituximab, infliximab 69 - 73 , antibiotics meropenem, minocycline, ciprofloxacin, rifampicin 73 - 79 , antimycotics griseofulvin, itraconazole 80 , 81 and other agents such as bupropion 82 , clopidogrel 83 , fluoxetine 84 , insulin detemir 85 , immunoglobulin 86 , mesalamine 87 , or streptokinase SSLRs usually occur weeks after drug exposure and resolve soon after drug discontinuation The suspected drugs should be avoided by patients who had SSLRs. The underlying cause of SSLRs remains unknown. Therefore, treatment is symptomatic, consisting in identification and discontinuation of the offending drug. It is unclear whether a short course of systemic glucocorticoids improves SSLRs Acneiform eruptions are pustular induced eruptions by drugs that often affects the arms and legs at variance from acne vulgaris. The lesions are usually monomorphous and heal without scarring. They occur with iodides, bromides, adrenocorticotropic hormone, corticosteroids, isoniazid, androgens, lithium, actinomycin D, and phenytoin. Topical medications that are oil-based could be the cause of a type of acne known as pomade acne. Sometimes corticosteroids worsening testosterone-induced acne within 2 weeks by the beginning of treatment. The risk appears to be directly proportional to the dose and duration of the therapy and severity of pre-existent acne Treatments is the same as acne vulgaris and include topical benzoyl peroxide, topical antibiotics, and topical tretinoin CADRs are a frequent reason of primary care visit In childhood there is a misattribution of cutaneous drug reactions. Diagnosis could be difficult because CADRs can closely mimic other diseases e. CADRs are confirmed with a drug challenge in a very low number of cases 92 , In the case of a true allergy the drug involved should be avoided. On the other hand, an incorrect diagnosis can limit therapeutic options and increase the risk of using more toxic, less effective and more expensive drugs A detailed history is necessary in order to evaluate the real occurrence of the adverse reaction. Therefore, good management of suspected CADRs requires an efficient method of estimating the probability of the drug reaction. Causality assessments based on clinical history, such as the Naranjo assessment 94 , have proven to be a valid method of estimating the probability of ADR 18 , 95 - but provocation test is the gold standard in the diagnosis of ADR As a library, NLM provides access to scientific literature. Acta Biomed. Find articles by Crisafulli Giuseppe. Find articles by Franceschini Fabrizio. Find articles by Caimmi Silvia. Find articles by Bottau Paolo. Find articles by Liotti Lucia. Find articles by Saretta Francesca. Find articles by Bernardini Roberto. Find articles by Cardinale Fabio. Find articles by Mori Francesca. Find articles by Caffarelli Carlo. Received Jan 24; Accepted Feb 1. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

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