Drug eruption (drug rash)

A drug erup­ti­on is a skin rash occur­ring as a reac­tion to a medi­ca­ti­on. It is one of the most com­mon adver­se drug reac­tions and typi­cal­ly appears a few days after tre­at­ment begins.

Cau­ses

The under­ly­ing mecha­nism is usual­ly a delay­ed immu­ne reac­tion against the acti­ve sub­s­tance or one of its meta­boli­tes. It is par­ti­cu­lar­ly often trig­ge­red by anti­bio­tics, pain­kil­lers and anti-rheu­ma­tic drugs, anti­epi­lep­tics and gout medi­ca­ti­ons. On rene­wed inta­ke of the same drug the reac­tion usual­ly occurs fas­ter and more strongly.

Sym­ptoms

Typi­cal are sym­me­tri­cal­ly dis­tri­bu­ted red macu­les and papu­les that start on the trunk and spread to the arms and legs, accom­pa­nied by itching. War­ning signs of a seve­re cour­se are blis­te­ring, invol­vement of the mucous mem­bra­nes, fever, facial swel­ling and a mark­ed fee­ling of ill­ness. In the­se cases imme­dia­te medi­cal assess­ment is required.

Tre­at­ment

The most important step is stop­ping the cau­sa­ti­ve medi­ca­ti­on under medi­cal super­vi­si­on. Itching and inflamm­a­ti­on are trea­ted with anti­hist­ami­nes and cor­ti­cos­te­ro­id pre­pa­ra­ti­ons, and the rash usual­ly subs­i­des within one to two weeks. After heal­ing, an aller­gy work-up is advi­sa­ble; the trig­ger belongs in the pati­en­t’s aller­gy passport.