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Drug eruptions

Andrew D Samel, MD
Chia-Yu Chu, MD, PhD
Section Editors
Robert P Dellavalle, MD, PhD, MSPH
Maja Mockenhaupt, MD, PhD
Jean-Claude Roujeau, MD
Deputy Editor
Rosamaria Corona, MD, DSc


Adverse cutaneous reactions to drugs are common, affecting 2 to 3 percent of hospitalized patients [1]. It is estimated that 1 in 1000 hospitalized patients has a serious cutaneous drug reaction [1]. Adverse cutaneous reactions to drugs also are a significant cause of outpatient morbidity since many patients are labeled "allergic" to a medication.

Classic and uncommon cutaneous drug reactions will be reviewed here. Drug allergy, hypersensitivity reactions, and infusion reactions and cutaneous complications of antineoplastic drugs are discussed elsewhere.

(See "Drug allergy: Classification and clinical features".)

(See "Hypersensitivity reactions to macrolides, aminoglycosides, tetracyclines, clindamycin, and metronidazole".)

(See "Hypersensitivity reactions to fluoroquinolones".)


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Literature review current through: Sep 2016. | This topic last updated: Oct 3, 2016.
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  1. Roujeau JC, Stern RS. Severe adverse cutaneous reactions to drugs. N Engl J Med 1994; 331:1272.
  2. Bigby M. Rates of cutaneous reactions to drugs. Arch Dermatol 2001; 137:765.
  3. Stern RS, Shear NH. Cutaneous reactions to drugs and biological modifiers. In: Cutaneous Medicine and Surgery, Arndt KA, LeBoit PE, Robinson JK, Wintroub BU (Eds), WB Saunders, Philadelphia 1996. Vol 1, p.412.
  4. Häusermann P, Harr T, Bircher AJ. Baboon syndrome resulting from systemic drugs: is there strife between SDRIFE and allergic contact dermatitis syndrome? Contact Dermatitis 2004; 51:297.
  5. Thyssen JP, Maibach HI. Drug-elicited systemic allergic (contact) dermatitis--update and possible pathomechanisms. Contact Dermatitis 2008; 59:195.
  6. Liew WK, Williamson E, Tang ML. Anaphylaxis fatalities and admissions in Australia. J Allergy Clin Immunol 2009; 123:434.
  7. Simons FE, Ardusso LR, Dimov V, et al. World Allergy Organization Anaphylaxis Guidelines: 2013 update of the evidence base. Int Arch Allergy Immunol 2013; 162:193.
  8. Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 2013; 65:1.
  9. Loricera J, Blanco R, Ortiz-Sanjuán F, et al. Single-organ cutaneous small-vessel vasculitis according to the 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides: a study of 60 patients from a series of 766 cutaneous vasculitis cases. Rheumatology (Oxford) 2015; 54:77.
  10. Khetan P, Sethuraman G, Khaitan BK, et al. An aetiological & clinicopathological study on cutaneous vasculitis. Indian J Med Res 2012; 135:107.
  11. Pendergraft WF 3rd, Niles JL. Trojan horses: drug culprits associated with antineutrophil cytoplasmic autoantibody (ANCA) vasculitis. Curr Opin Rheumatol 2014; 26:42.
  12. Calabrese LH, Duna GF. Drug-induced vasculitis. Curr Opin Rheumatol 1996; 8:34.
  13. Parker CW. Allergic reactions in man. Pharmacol Rev 1982; 34:85.
  14. Mullick FG, McAllister HA Jr, Wagner BM, Fenoglio JJ Jr. Drug related vasculitis. Clinicopathologic correlations in 30 patients. Hum Pathol 1979; 10:313.
  15. Martinez-Taboada VM, Blanco R, Garcia-Fuentes M, Rodriguez-Valverde V. Clinical features and outcome of 95 patients with hypersensitivity vasculitis. Am J Med 1997; 102:186.
  16. Dermatology in General Medicine, 4th ed, Fitzpatrick TB, Eisen AZ, Wolff K, et al (Eds), McGraw-Hill, New York 1993. p.528.
  17. Auquier-Dunant A, Mockenhaupt M, Naldi L, et al. Correlations between clinical patterns and causes of erythema multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis: results of an international prospective study. Arch Dermatol 2002; 138:1019.
  18. de Frutos C, de Barrio M, Tornero P, et al. Erythema multiforme from sulfaguanidine. Contact Dermatitis 2002; 46:186.
  19. Forman R, Koren G, Shear NH. Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis in children: a review of 10 years' experience. Drug Saf 2002; 25:965.
  20. Bocquet H, Bagot M, Roujeau JC. Drug-induced pseudolymphoma and drug hypersensitivity syndrome (Drug Rash with Eosinophilia and Systemic Symptoms: DRESS). Semin Cutan Med Surg 1996; 15:250.
  21. Kardaun SH, Sidoroff A, Valeyrie-Allanore L, et al. Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms: does a DRESS syndrome really exist? Br J Dermatol 2007; 156:609.
  22. Kardaun SH, Sekula P, Valeyrie-Allanore L, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. Br J Dermatol 2013; 169:1071.
  23. Cho YT, Lin JW, Chen YC, et al. Generalized bullous fixed drug eruption is distinct from Stevens-Johnson syndrome/toxic epidermal necrolysis by immunohistopathological features. J Am Acad Dermatol 2014; 70:539.
  24. Namazy JA, Simon RA. Sensitivity to nonsteroidal anti-inflammatory drugs. Ann Allergy Asthma Immunol 2002; 89:542.
  25. Mahboob A, Haroon TS. Drugs causing fixed eruptions: a study of 450 cases. Int J Dermatol 1998; 37:833.
  26. Brahimi N, Routier E, Raison-Peyron N, et al. A three-year-analysis of fixed drug eruptions in hospital settings in France. Eur J Dermatol 2010; 20:461.
  27. González E, González S. Drug photosensitivity, idiopathic photodermatoses, and sunscreens. J Am Acad Dermatol 1996; 35:871.
  28. Brenner S, Goldberg I. Drug-induced pemphigus. Clin Dermatol 2011; 29:455.
  29. Brenner S, Bialy-Golan A, Ruocco V. Drug-induced pemphigus. Clin Dermatol 1998; 16:393.
  30. Smith EP, Taylor TB, Meyer LJ, Zone JJ. Antigen identification in drug-induced bullous pemphigoid. J Am Acad Dermatol 1993; 29:879.
  31. Vassileva S. Drug-induced pemphigoid: bullous and cicatricial. Clin Dermatol 1998; 16:379.
  32. Lee JJ, Downham TF 2nd. Furosemide-induced bullous pemphigoid: case report and review of literature. J Drugs Dermatol 2006; 5:562.
  33. Baz K, Ikizoglu G, Kaya TI, Koca A. Furosemide-induced bullous pemphigoid. J Eur Acad Dermatol Venereol 2002; 16:81.
  34. Mallet L, Cooper JW, Thomas J. Bullous pemphigoid associated with captopril. DICP 1989; 23:63.
  35. Wozniak K, Kowalewski C, Hashimoto T, et al. Penicillin-induced anti-p200 pemphigoid: an unusual morphology. Acta Derm Venereol 2006; 86:443.
  36. Bart BJ, Bean SF. Bullous pemphigoid following the topical use of fluorouracil. Arch Dermatol 1970; 102:457.
  37. Bastuji-Garin S, Joly P, Lemordant P, et al. Risk factors for bullous pemphigoid in the elderly: a prospective case-control study. J Invest Dermatol 2011; 131:637.
  38. Lloyd-Lavery A, Chi CC, Wojnarowska F, Taghipour K. The associations between bullous pemphigoid and drug use: a UK case-control study. JAMA Dermatol 2013; 149:58.
  39. Bastuji-Garin S, Joly P, Picard-Dahan C, et al. Drugs associated with bullous pemphigoid. A case-control study. Arch Dermatol 1996; 132:272.
  40. Kuechle MK, Stegemeir E, Maynard B, et al. Drug-induced linear IgA bullous dermatosis: report of six cases and review of the literature. J Am Acad Dermatol 1994; 30:187.
  41. Halevy S. Acute generalized exanthematous pustulosis. Curr Opin Allergy Clin Immunol 2009; 9:322.
  42. Roujeau JC, Bioulac-Sage P, Bourseau C, et al. Acute generalized exanthematous pustulosis. Analysis of 63 cases. Arch Dermatol 1991; 127:1333.
  43. Momin SB, Del Rosso JQ, Michaels B, Mobini N. Acute generalized exanthematous pustulosis: an enigmatic drug-induced reaction. Cutis 2009; 83:291.
  44. Sidoroff A, Dunant A, Viboud C, et al. Risk factors for acute generalized exanthematous pustulosis (AGEP)-results of a multinational case-control study (EuroSCAR). Br J Dermatol 2007; 157:989.
  45. Thompson DF, Skaehill PA. Drug-induced lichen planus. Pharmacotherapy 1994; 14:561.
  46. Tosi A, Misciali C, Piraccini BM, et al. Drug-induced hair loss and hair growth. Incidence, management and avoidance. Drug Saf 1994; 10:310.
  47. Gilliam AC, Wood GS. Cutaneous lymphoid hyperplasias. Semin Cutan Med Surg 2000; 19:133.
  48. Breza TS Jr, Zheng P, Porcu P, Magro CM. Cutaneous marginal zone B-cell lymphoma in the setting of fluoxetine therapy: a hypothesis regarding pathogenesis based on in vitro suppression of T-cell-proliferative response. J Cutan Pathol 2006; 33:522.
  49. Jung J, Levin EC, Jarrett R, et al. Lymphomatoid drug reaction to ustekinumab. Arch Dermatol 2011; 147:992.
  50. Fukamachi S, Sugita K, Sawada Y, et al. Drug-induced CD30+ T cell pseudolymphoma. Eur J Dermatol 2009; 19:292.
  51. Crowson AN, Magro CM. Antidepressant therapy. A possible cause of atypical cutaneous lymphoid hyperplasia. Arch Dermatol 1995; 131:925.
  52. Yang CH, Lin WC, Chuang CK, et al. Hand-foot skin reaction in patients treated with sorafenib: a clinicopathological study of cutaneous manifestations due to multitargeted kinase inhibitor therapy. Br J Dermatol 2008; 158:592.
  53. Fritzler MJ. Drugs recently associated with lupus syndromes. Lupus 1994; 3:455.
  54. Bauer KA. Coumarin-induced skin necrosis. Arch Dermatol 1993; 129:766.
  55. Broekmans AW, Teepe RG, van der Meer FJ, et al. Protein C (PC) and coumarin-induced skin necrosis. Thromb Res 1986; 6:137.
  56. Schindewolf M, Lindhoff-Last E, Ludwig RJ, Boehncke WH. Heparin-induced skin lesions. Lancet 2012; 380:1867.
  57. Warkentin TE, Greinacher A. Heparin-induced anaphylactic and anaphylactoid reactions: two distinct but overlapping syndromes. Expert Opin Drug Saf 2009; 8:129.
  58. Menajovsky LB. Heparin-induced thrombocytopenia: clinical manifestations and management strategies. Am J Med 2005; 118 Suppl 8A:21S.
  59. Handschin AE, Trentz O, Kock HJ, Wanner GA. Low molecular weight heparin-induced skin necrosis-a systematic review. Langenbecks Arch Surg 2005; 390:249.
  60. Sack U, Kuhn H, Ermann J, et al. Synovial tissue implants from patients with rheumatoid arthritis cause cartilage destruction in knee joints of SCID.bg mice. J Rheumatol 1994; 21:10.
  61. Gupta AK, Knowles SR, Gupta MA, et al. Lithium therapy associated with hidradenitis suppurativa: case report and a review of the dermatologic side effects of lithium. J Am Acad Dermatol 1995; 32:382.
  62. Crowson AN, Brown TJ, Magro CM. Progress in the understanding of the pathology and pathogenesis of cutaneous drug eruptions : implications for management. Am J Clin Dermatol 2003; 4:407.
  63. Chang MW, Miner JE, Moiin A, Hashimoto K. Iododerma after computed tomographic scan with intravenous radiopaque contrast media. J Am Acad Dermatol 1997; 36:1014.
  64. Johnson ML, Grimwood RE. Leukocyte colony-stimulating factors. A review of associated neutrophilic dermatoses and vasculitides. Arch Dermatol 1994; 130:77.
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