Also known as a drug eruption, a drug rash is a reaction your skin has to certain drugs. Any type of drug can cause a rash, but it is usually more common with antibiotics, especially sulfa drugs and penicillins, anti-seizure drugs, and NSAIDs (nonsteroidal anti-inflammatory drugs). A drug rash is best described as an adverse drug reaction that happens on the skin. Most reactions are typically mild and tend to disappear on their own once the drug is withdrawn. However, there are instances when some drugs can cause serious drug eruption, which might even be associated with kidney or liver damage. This is why it is important to identify a drug rash in time and get the proper treatment for the same. Read on to find out how identifying and treating a drug rash can prevent any serious reactions from happening.

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What is a Drug Rash?

Also known as a drug eruption, a drug rash is an adverse reaction your skin has to a certain medication. Any type of drug can cause a rash, but there are certain medications that are more likely to cause drug rashes than others. These include:(1)

  • Antibiotics, especially sulfa drugs and drugs from the penicillin family
  • NSAIDs
  • Anti-seizure drugs

Identifying a Drug Rash

Most drug rashes appear on the skin and are usually symmetric in appearance. This means that they should appear in the same manner and on both the parts of your body. For example, if you have a drug rash, on one hand, your other hand is also likely to get affected.

Drug rashes may or may not cause any other symptoms except for their appearance, though some drug rashes might be accompanied by tenderness of the skin and itching.
It is possible to separate a drug rash from another type of rashes as these will coincide with the time period of starting a new medication. However, in some cases, it can take a drug up to two weeks to cause a rash. You will notice that once you stop taking the drug, your rash will typically disappear on its own.(2)

Some of the more common types of drug rashes are discussed below.

Exanthematous Drug Rashes

Exanthematous drug rash is the most commonly occurring type of drug eruption. It makes up for nearly 90 percent of all the cases of drug rashes. This type of drug eruption is marked by small lesions on reddened skin. You might also experience blisters along with pus-filled lesions. These lesions can either be flat or they can be raised.(3)

Some of the common drugs that cause exanthematous drug eruptions include:

  • Sulfa drugs
  • Allopurinol
  • Anti-seizure drugs
  • Penicillins
  • Cephalosporins

Photosensitivity Drug Reactions

There are certain types of drugs that make your skin become extra sensitive to ultraviolet light. This causes an itchy sunburn kind of reaction on the skin if you go out in the sun without wearing proper sun protection on your skin.(4) Some of the common drugs that are known to cause photosensitivity reactions to include:

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  • Sulfa drugs
  • Antibiotics such as tetracycline
  • Statins
  • Antifungals
  • Antihistamines
  • Some NSAIDs
  • Diuretics
  • Retinoids including isotretinoin

Erythroderma

Erythroderma is a type of drug rash that causes almost all the skin of your body to become red and itchy. In some people, the skin may also start to grow scale and feel hot to the touch. This type of drug rash is also accompanied by a fever. Some of the drugs that can cause this type of drug rash include:(5)

  • Isoniazid
  • Sulfa drugs
  • Anti-seizure drugs
  • Penicillins
  • Chloroquine
  • Allopurinol

Sometimes, an underlying health condition can also cause erythroderma. If you suspect that you have erythroderma, then you must seek medical attention at once because erythroderma can be a serious and life-threatening condition.

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Urticarial Rashes

Urticarial rashes are term used to refer to hives. Hives are today the second most common type of drug eruptions. They are pale, small, and red bumps that can also form in larger patches. Hives are generally very itchy.(6) The common drugs that can cause urticarial drug eruptions are:

  • ACE inhibitors
  • General anesthetics
  • NSAIDs
  • Antibiotics, particularly penicillin

Toxic Epidermal Necrolysis (TEN) and Stevens - Johnson Syndrome (SJS)

TEN and SJS are more or less considered to be the same condition, but there is still a minor difference between these two. TEN involves rashes that occur on more than 30 percent of the body, while SJS involves rashes that occur in less than 10 percent of the body. Both these conditions are characterized by the appearance of large and painful blisters. Both SJS and TEN can also cause large areas of the topmost layer of your skin to peel off, leaving open and raw sores.(7)

The drugs that are commonly associated with these two conditions include:

  • Certain NSAIDs
  • Nevirapine
  • Sulfa drugs
  • Anti-seizure drugs
  • Allopurinol

Similar to erythroderma, both TEN and SJS are considered to be severe reactions and can prove to be life-threatening. This is why both these conditions require immediate medical attention.

Anticoagulant-induced Skin Necrosis

Anticoagulant-induced skin necrosis is also a type of adverse drug reaction that is usually caused by certain blood thinners, such as warfarin. This drug eruption causes the skin to become painful and red. Over a period of time, the tissues underneath the skin start to die. This condition generally only happens at the very start of taking quite a high dose of a blood thinner.

If you believe you are experiencing symptoms of anticoagulant-induced skin necrosis then you must seek medical attention at once as this is a serious condition that needs treatment at the earliest.

DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms)

DRESS is a type of rare drug rash that can be fatal if not treated at the earliest. In people who develop DRESS, it takes around two to six weeks from starting a new drug for the symptoms to start appearing. A DRESS rash appears to be red and usually begins on the face and the upper body. Other accompanying symptoms are usually severe and even involve some internal organs. (8) Common symptoms of DRESS include:

Some of the drugs that can cause a DRESS rash include:

  • Allopurinol
  • Abacavir
  • Proton pump inhibitors
  • Sulfasalazine
  • Minocycline
  • Anticonvulsants

If you experience any of these symptoms, immediately seek medical attention as DRESS is a life-threatening condition.

What Causes Drug Rashes?

There are several reasons why drug rashes happen to some people and do not affect others. Some of these reasons can include:

  • Interaction of two or more drugs
  • A drug that makes your skin become more sensitive to the sunlight
  • Having an allergic reaction
  • A buildup of the drugs that causes toxicity to the skin

Sometimes, though, a drug rash can happen as a spontaneous reaction and without any cause.

There are certain factors that increase your risk of developing a drug rash. These include:

  • Being elderly
  • Being a female
  • Having a viral infection and taking an antibiotic
  • Having a weakened immune system due to an underlying medical condition or any other drug
  • Having cancer

Treatment of Drug Rashes

In the majority of cases, drug rashes tend to simply go away on their own once you withdraw the drug, meaning you stop taking the drug that caused the reaction.

If you have a very itchy rash, then an oral steroid or an antihistamine will help you manage the symptom of itching until the rash clears up.

If you experience an adverse reaction to a drug, then never discontinue the drug without talking to your doctor first. This is especially critical if you are taking multiple drugs. In this situation, your doctor will come up with a specific plan of discontinuing each individual medication until it has been figured out as to which drug is causing the adverse reaction.

If you have erythroderma, urticaria, TEN/SJS, DRESS, or anticoagulant-induced skin necrosis, then you will need immediate intensive treatment, which might include hydration and intravenous steroids.

Conclusion

In most cases, a drug rash is nothing to worry about and it will clear up on its own once the medication causing it is stopped. Just make sure that you discuss with your doctor before stopping any prescribed medication. If you are experiencing severe symptoms of a drug rash, then it is important that you head over to the emergency room immediately so that timely treatment can prevent any serious complications.

References:  

  1. Nigen, S., Knowles, S.R. and Shear, N.H., 2003. Drug eruptions: approaching the diagnosis of drug-induced skin diseases. Journal of drugs in dermatology: JDD, 2(3), pp.278-299.
  2. Ardern‐Jones, M.R. and Friedmann, P.S., 2011. Skin manifestations of drug allergy. British journal of clinical pharmacology, 71(5), pp.672-683.
  3. Absmaier, M., Biedermann, T. and Brockow, K., 2017. Triggers of exanthematous drug eruptions: Stop intake, treat through or desensitization?. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete, 68(1), pp.29-35.
  4. Monteiro, A.F., Rato, M. and Martins, C., 2016. Drug-induced photosensitivity: Photoallergic and phototoxic reactions. Clinics in dermatology, 34(5), pp.571-581.
  5. Okoduwa, C., Lambert, W.C., Schwartz, R.A., Kubeyinje, E., Eitokpah, A., Sinha, S. and Chen, W., 2009. Erythroderma: review of a potentially life-threatening dermatosis. Indian journal of dermatology, 54(1), p.1.
  6. Maurer, M. and Grabbe, J., 2008. Urticaria: its history-based diagnosis and etiologically oriented treatment. Deutsches Ärzteblatt International, 105(25), p.458.
  7. Harr, T. and French, L.E., 2010. Toxic epidermal necrolysis and Stevens-Johnson syndrome. Orphanet journal of rare diseases, 5(1), p.39.
  8. Choudhary, S., McLeod, M., Torchia, D. and Romanelli, P., 2013. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. The Journal of clinical and aesthetic dermatology, 6(6), p.31.

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Sheetal DeCaria MD

Written, Edited or Reviewed By:

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Last Modified On: June 19, 2019

This article does not provide medical advice. See disclaimer

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