TABLE 1

Characteristics of selected high-risk drug rashesa

DiseaseOnsetSkin findingsHallmarksDrug triggersDiagnosisb
SJS/TEN1–3 weeksRed/purple macules progressing to vesicles, erosions, and ulcerationsMucous membrane involvement; Nikolsky signAllopurinol, antibiotics (particularly sulfonamide), antiepileptics, NSAIDsSCORTEN
DRESS2–6 weeksGeneralized maculopapular erythematous rashFacial edema and redness, eosinophilia, elevated transaminasesAllopurinol, antibiotics, antiepileptics, antiretrovirals, isoniazid, NSAIDsRegiSCAR
AGEP48 hoursGeneralized maculopapular erythematous rash with pinpoint pustulesFace, trunk, and intertriginous area; tiny pustules often difficult to seeAntibiotics, antimycotics, diltiazem, hydroxychloroquineEuroSCAR; consider dermatoscopy
Drug-induced vasculitis1–3 weeksPalpable purpuraDependent areas, reverse koebnerizationAllopurinol, amiodarone, antibiotics, beta-blockers, diuretics, metformin, NSAIDs, SSRIsEvaluate 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