Phenobarbital, which was introduced clinically in 1911, is still one of the most frequently prescribed drugs in the United States. The fact that it can provoke an extremely severe and grave reaction may be easily overlooked by the busy practitioner, who is more aware of its great clinical utility. That it does so on relatively rare occasions (considering the vast amounts of it which are used) is most fortunate. Nevertheless, the literature contains numerous reports of a wide variety of eruptions attributed to phenobarbital; these include the generalized morbilliform or scarlatiniform rash, the bullous erythema multiforme, the discrete coin-sized violaceous macules of the "fixed eruption" type, urticaria and the generalized or universal exfoliative dermatitis, which may be fatal. It is clear, then, that every physician who prescribes this drug (or any other barbiturate) should be familiar with and constantly on the watch for the early warning signs of intolerance. Although
WELTON DG. EXFOLIATIVE DERMATITIS AND HEPATITIS DUE TO PHENOBARBITAL. JAMA. 1950;143(3):232–234. doi:10.1001/jama.1950.02910380016006
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