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
Onset of eruption2-6 weeks1-3 weeks48 hours1-3 weeks
Duration of eruption (weeks)Several1-3<1Several
Fever++++++++++++
Mucocutaneous featuresFacial edema, morbilliform eruption, pustules, exfoliative dermattiis, tense bullae, possible target lesionsBullae, atypical target lesions, mucocutaneous erosionsFacial edema, pustules, tense bullae, possible target lesions, possibl emucosal involvementErythematous plaques and edema affecting >90% of total skin surface with or without diffuse exfoliation
Lymph node enlargement+++-++
NeutrophilsElevatedDecreasedVery elevatedElevated
EosinophilsVery elevatedNo changeElevatedElevated
Atypical lymphocytes+--+
Hepatitis+++++++-
Other organ involvementInterstitial nephritis, pneumonitis, myocarditis, and thydoiditisTubular nephritis and tracheobronical necrosisPossiblePossible
Histological pattern of skinPerivascular lymphocytcic infiltrateEpidermal necrosisSubcorneal pustulesNonspecific, unless reflecting Sezary syndrome or other lymphoma
Lymph node histologyLymphoid hyperplasia--No, unless reflecting Sezary syndrome or other malignancy
Mortality (%)105-3555-15

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


References
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