Drug rash - what is it? When do drug rashes appear and how to treat them? Drug rashes vary in form depending on how the body responds to medication.

Drug rash is a term used in dermatology to describe skin lesions that appear on the skin or mucous membranes. Drug rashes are a skin manifestation of an allergy to pharmaceuticals.

Contents:

    1. Drug rash - what is it?
    2. Drug rash - differentiation of symptoms
    3. Drug rash - drugs and autoimmune diseases
    4. Drug rash - diagnosis and treatment

It should be remembered that drug rashes are not the only types of rash distinguished in dermatology. They appear on the skin or mucous membranes and are an allergic reaction of the body to medications taken. Symptoms of drug-induced rashes include, among others: persistent erythema, erythema multiforme, erythema nodosum. Symptoms of drug eruptions depend on the type of medication taken and we can distinguish among them, among others, permanent or nodular erythema.

Drug rash - what is it?

Drug rash is a cutaneous manifestation of an allergic reaction to medications. It usually appears three weeks after starting the use of the drug substance. Symptoms of immune responses to drugs include:

  • permanent erythema - usually takes the form of a single, well-delimited, brown bloom. Most often it is caused by barbiturates, acetylsalicylic acid, aminophenazone, sulfonamides. Discontinuation of a specific drug results in the disease regressing.
  • changes of the erythema multiforme type (erythema multiforme) with the Stevens Johnson variety - blisters and even erosions appear on the mucous membranes of the mouth, eyes and genitals. Skin changes are accompanied by fever and joint pain. Drugs associated with the appearance of this rash include sulfa drugs, barbiturates, and penicillin and its derivatives. The treatment uses broad-spectrum antibiotics together with desensitizing drugs such as calcium or antihistamines.
  • changes of the erythema mutliforme type, of the type of toxic epidermal necrolysis - erythematous changes andblistering, which contribute to the creeping of the epidermis with whole flaps. The skin symptoms are accompanied by high fever and the patient's serious condition. This is a very serious complication of treatment as it can even be fatal. It can be induced by sulfonamides, barbiturates, penicillin along with derivatives, as well as furosemide. Due to extensive skin lesions, which result in electrolyte disturbances, multi-electrolyte fluids and plasma are administered to improve the patient's condition. The use of cyclophosphamide with prednisone also turns out to be effective.
  • erythema nodosum (erythema nodosum) lesions - tumors that can cause pain usually appear in the lower leg area, are red, but may turn blue-brown over time. There is also pain in the joints and increased body temperature. The most common cause is the use of sulfonamides or penicillin. Discontinuation of the substances responsible for the reaction is often enough to improve the patient's condition.
  • haemorrhagic changes - appear as skin bruising. They can be caused by thiazides, gold, sulfonamides, allopurinol, non-steroidal anti-inflammatory drugs and penicillin derivatives. Treatment is based on the use of corticosteroids with immunosuppressants.
  • iodine - these are changes on the skin and mucous membranes that occur as a result of long-term use of small doses of iodine. They can take the form of hives, tightly stretched hemorrhagic blisters, and papules and pimples similar to those found in acne. In allergic patients, administration of radiological contrast agents may cause very serious reactions, even with death.
  • bromica - this is a characteristic disease resulting from the use of bromide. The most common form are acne-like and rocking lesions. Blisters appear much less frequently.

Drug rash - differentiation of symptoms

There is also a group of symptoms that may be medication-related, but also occur in the course of other diseases. Examples of such changes are for example:

  • hives and swelling - blisters of various shapes appear on the surface of the skin, usually swollen with a pinkish or paler color than the rest of the skin. Drugs that cause them include acetylsalicylic acid and barbiturates. Other factors that cause hives can be the food you eat, inhaled allergens, and low and high temperatures. Relief is provided by the use of antihistamines and calcium. Urticaria can also occur in the course of an immune reaction that leads to the most serious form of allergy, i.e. shockanaphylactic. Other symptoms of shock are rapid heart rate, low blood pressure, retrosternal pain, itching, convulsions, shortness of breath and vomiting. It occurs through the use of procaine or penicillin. In critical situations in the hospital, intravenous adrenaline and intramuscular hydrocortisone solutions are administered.
  • lichen planus lesions - caused by gold s alts, antimalarials, thiazides, phenothiazine, furosemide, propranolol. The mainstay of treatment is the use of corticosteroids.
  • phototoxic reactions - occur with the use of oral drugs such as psoralens, sulfonamides, tetracyclines, griseofulvin, antiarrhythmic drugs, antihypertensive drugs, antiepileptic drugs or external drugs such as furocoumarin, tar and dyes. These substances increase the skin's sensitivity to ultraviolet radiation and can lead to discoloration.
  • photoallergic reactions may arise when using drugs such as sulfonamides, chlorothiazide, tranquilizers, phenothiazines, salicylanilides, hexachlorophene, paraaminobenzoic acid.
  • pustular eruptions - may be caused by carbamazepine, chloramphenicol, furosemide or phenytoin.
  • acute generalized exanthematous pustulosis, AGEP - pustular eruptions not related to the hair follicles appear on the skin. The accompanying symptom is fever and the epidermis may be shedding. Treatment consists of the administration of cyclosporine or immunosuppressants.
  • acne rashes - the most common areas of the face and back are blackheads, papules and pimples. They appear as a result of the use of corticosteroids, oral contraceptives, isoniazid, haloperidol. The therapy uses anti-seborrheic, keratolytic, anti-inflammatory drugs and even antibiotics such as tetracyclines or erythromycin.
  • alopecia - hair loss can also be caused by the use of pharmaceuticals. The most common substances with such effects are cytostatic and immunosuppressive drugs such as cyclophosphamide and methotrexate, but antithyroid drugs, oral contraceptives, retinoids and anticoagulants such as coumarin or heparin also contribute.
  • changes in the nails - usually manifested by discoloration caused by fluorouracil, antimalarial agents, and silver or gold s alts.
Types of rash

Rash in dermatology means changes that appear on the skin or mucous membranes. Due to their appearance, there are several types of rash.

Mention the types:

  • Spotted rash - appears as flat lesions of a different color, often more reddened than the rest of the skin.
  • Macular-papular rash - occurs when the color change is accompanied by papules, which are tiny, harder protrusions.
  • Papular rash - it is devoid of erythematous changes in the color of the skin, there are only papules.
  • Lichen-like rash - skin lesions resemble lichen skin, papules are shiny, may be linear
  • Pustular rash - it is characterized by numerous pimples not related to the hair follicles

Drug rash - drugs and autoimmune diseases

Drug rash is not the only negative symptom of drug use. The use of certain drugs can also induce specific autoimmune diseases, such as:

  • vesicles - arise from the use of penicillamine, captopril and phenylbutazone. There are pemphigus and pemphigus. Pemphigus vulgaris is characterized by changes in the mucous membranes and skin in the form of blisters and erosions. The epidermis may creep.

In the case of deciduous pemphigus, eruptions in the form of exfoliating erosions and shallow blisters are characteristic.

Treatment of pemphigus involves the use of corticosteroids combined with immunosuppressive drugs due to the autoimmune causes of the disease. The most frequently used immunosuppressants in this case are cyclophosphamide, methotrexate and azathioprine.

  • pemphigoid - shows up as bullous, erythematous or urticarial lesions. May be induced by furosemide, ibuprofen, penicillamine, salazosulfapyridine. The treatment uses corticosteroids.
  • linear IgA bullous dermatosis - takes the form of grouped, large and well-stretched blisters occurring on the basis of erythematous-edema lesions. Vancomycin, rifampicin, phenytoin and captopril contribute to the changes. The use of sulfapyridine or sulfones in combination with corticosteroids is recommended.
  • acquired blistering epidermal separation - large blisters appear in the areas exposed to injuries, accompanied by itching. The changes may be related to the use of sulfonamides, sulfamethoxypyridazine, furosemide and penicillamine. Treatment is based on sulfones in combination with corticosteroids.
  • lupus erythematosus - eruptions in the form of erythematosus occur within the face taking the characteristic shape of a butterfly. It can be induced by hydralazine, hydantoin, isoniazid andstreptomycin. The therapy uses corticosteroids and immunosuppressive drugs.

Drug rash - diagnosis and treatment

Drug rash manifests itself in various forms on the skin and often discontinuation of the drug responsible for the reaction is enough to reverse it. However, it is always worth visiting a doctor for a thorough diagnosis and proper treatment, because some seemingly insignificant symptoms may precede critical conditions, leading even to death.

Diagnostics is largely based on collecting a thorough history of the substances used. Exposure or intradermal tests are also frequently performed. These tests are usually only performed in hospitals due to the high risk of reactions leading to anaphylactic shock. The intradermal tests consist of the intradermal injection of various concentrations of the test drug.

For contact allergy tests, epidermal patch tests may also be used, based on placing the test substance on a tissue paper on the skin and covering the area with foil. Results are read after 48 and 72 hours. In cases confirming an allergy, the skin develops erythema or eczema.

The radio-allergic-absorption test (RAST) is also used in the diagnosis of urticarial drug rashes. It enables the detection of specific IgE antibodies in the blood, which are produced in the body against specific allergens, which in this case are pharmaceuticals.

We recommend: Permanent drug erythema: causes, symptoms, treatment

About the authorJoanna Mazurek

Student of medicine. He is passionate about he alth and everything related to it, including he althy eating. In his spare time, he is engaged in reading crime novels and strength training.

Category:

Dermatology