Drug rash

Background

ABCs of Drug Rashes

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

Evaluation

  • Typically a clinical diagnosis

Table of Severe Drug Rashes

Charateristic DRESS SJS/TEN AGEP Erythroderma
Image PMC3894017 JFMPC-2-83-g001.png Stevens-johnson-syndrome.jpg Acute generalized exanthematous pustulosis.png Red (burning) Skin Syndrome - Feet Collage.jpg
Onset of eruption 2-6 weeks 1-3 weeks 48 hours 1-3 weeks
Duration of eruption (weeks) Several 1-3 <1 Several
Fever +++ +++ +++ +++
Mucocutaneous features Facial edema, morbilliform eruption, pustules, exfoliative dermattiis, tense bullae, possible target lesions Bullae, atypical target lesions, mucocutaneous erosions Facial edema, pustules, tense bullae, possible target lesions, possibl emucosal involvement Erythematous plaques and edema affecting >90% of total skin surface with or without diffuse exfoliation
Lymph node enlargement +++ - + +
Neutrophils Elevated Decreased Very elevated Elevated
Eosinophils Very elevated No change Elevated Elevated
Atypical lymphocytes + - - +
Hepatitis +++ ++ ++ -
Other organ involvement Interstitial nephritis, pneumonitis, myocarditis, and thydoiditis Tubular nephritis and tracheobronical necrosis Possible Possible
Histological pattern of skin Perivascular lymphocytcic infiltrate Epidermal necrosis Subcorneal pustules Nonspecific, unless reflecting Sezary syndrome or other lymphoma
Lymph node histology Lymphoid hyperplasia - - No, unless reflecting Sezary syndrome or other malignancy
Mortality (%) 10 5-35 5 5-15

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

External Links

References