Characteristics of selected high-risk drug rashesa
Disease | Onset | Skin findings | Hallmarks | Drug triggers | Diagnosisb |
---|---|---|---|---|---|
SJS/TEN | 1–3 weeks | Red/purple macules progressing to vesicles, erosions, and ulcerations | Mucous membrane involvement; Nikolsky sign | Allopurinol, antibiotics (particularly sulfonamide), antiepileptics, NSAIDs | SCORTEN |
DRESS | 2–6 weeks | Generalized maculopapular erythematous rash | Facial edema and redness, eosinophilia, elevated transaminases | Allopurinol, antibiotics, antiepileptics, antiretrovirals, isoniazid, NSAIDs | RegiSCAR |
AGEP | 48 hours | Generalized maculopapular erythematous rash with pinpoint pustules | Face, trunk, and intertriginous area; tiny pustules often difficult to see | Antibiotics, antimycotics, diltiazem, hydroxychloroquine | EuroSCAR; consider dermatoscopy |
Drug-induced vasculitis | 1–3 weeks | Palpable purpura | Dependent areas, reverse koebnerization | Allopurinol, amiodarone, antibiotics, beta-blockers, diuretics, metformin, NSAIDs, SSRIs | Evaluate for alternative causes of systemic vasculitis |
↵a Treatment starts with immediate identification and cessation of the offending drug.
↵b Consider skin biopsy to further support diagnosis for all these rashes.
AGEP = acute generalized exanthematous pustulosis; DRESS = drug reaction with eosinophilia and systemic symptoms; EuroSCAR = European Study of Severe Cutaneous Adverse Reactions; NSAIDs = nonsteroidal anti-inflammatory drugs; RegiSCAR = Registry of Severe Cutaneous Adverse Reactions; SCORTEN = Severity-of-Illness Score for Toxic Epidermal Necrolysis; SJS/TEN = Stevens-Johnson syndrome/toxic epidermal necrolysis; SSRIs = selective serotonin reuptake inhibitors