Drug rash

Background

ABCs of Drug Rashes

• Acute generalized exanthematous pustulosis (AGEP)
• Bullous disease, drug induced
• Captopril (ACE-inhibitor) induced angioedema
• Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome
• SJS/TEN

Clinical Features

Morbilliform drug eruption on back

• Sudden, usually morbilliform, often starts on face & trunk & spreads
• More polymorphous than viral exanthem

Differential Diagnosis

Erythematous rash

• Positive Nikolsky’s sign
  • Febrile
    • Staphylococcal scalded skin syndrome (children)
    • Toxic epidermal necrolysis/SJS (adults)
  • Afebrile
    • Toxic epidermal necrolysis
• Negative Nikolsky’s sign
  • Febrile
    • Toxic shock syndrome
    • Kawasaki disease
    • Scarlet fever
    • DRESS syndrome
    • Cellulitis
    • Acute generalized exanthematous pustulosis
  • Afebrile
    • Alcohol intoxication
    • Anaphylaxis
    • Cellulitis
    • Dermatitis (multiple types)
    • Drug rash
    • Erysipelas
    • Erythema multiforme
    • Exfoliative erythroderma
    • Scombroid
    • Vancomycin infusion reaction

Evaluation

• Typically a clinical diagnosis

Management

• Discontinue offending agent
• Supportive
• Topical steroids may help relieve pruritus

Disposition

• If no signs of anaphylaxis or significant sloughing, consider outpatient management

See Also

• Rashes