Published in:
01-01-2000 | Practical Dermatology
Identifying Drug Rashes
Published in: American Journal of Clinical Dermatology | Issue 1/2000
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Cutaneous eruptions caused by medications are very common. They may be associated with overdosage, an unwanted pharmacological action or deposition of the drug in the skin. A reaction may be idosyncratic or allergic. The following photographs show a range of drug rashes that a practitioner may encounter.
Fig. 1
Maculopapular morbilliform. This is the commonest type of allergic reaction to antibacterials, especially amoxicillin, cephalosporins and gentamicin. It is also caused by phenothiazines, thiazides and barbiturates.
Fig. 2
Urticarias (hives) reactions. These reactions occur with penicillin, aspirin (acetylsalicylic acid), foreign serum and blood transfusions. Indomethacin, opioids, and insulin are sometimes implicated.
Fig. 3
Erythema multiforme. This reaction is characterised by circular (target) lesions on hands, feet and knees, which can affect mucous membranes. Sulfonamides, nonsteroidal anti-inflammatory drugs (NSAIDs), barbiturates and phenytoin are offenders.
Fig. 4
Hirsutism. This reaction can be caused by corticosteroids, diazoxide, cyclosporin, phenytoin, minoxidil and tamoxifen.
Fig. 5
Melasma-type pigmentation. Oral contraceptives or other hormones cause this appearance. Ultraviolet light is a cofactor. This can resemble photosensitivity from phenothiazine drugs.
Fig. 6
Thrombocytopenic purpura. Platelets can be affected/destroyed by various drug-induced mechanisms. This patient was receiving quinidine. Sulfonamides, gold and NSAIDs can also be responsible.
Fig. 7
Fixed-drug eruption. This unusual phenomenon recurs in the same site if readministration occurs. Tetracycline, phenolphthalein, quinidine and sulfonamides are implicated.
Fig. 8
Photosensitivity. Many medications are associated with this reaction. The list includes griseofulvin, phenothiazines, sulfonylureas, sulfonamides, thiazides, doxycycline, nalidixic acid and naproxen.
Fig. 9
Striae. These are caused by large doses of corticosteroids and anabolic steroid drugs.
Fig. 10
Vasculitis. This severe eruption was fatal. Thiazides, phenylbutazone, phenytoin, sulfonamides and indomethacin are known offenders.
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