What are the other Names for this Condition? (Also known as/Synonyms)

• Adverse Cutaneous Reactions to Drugs
• Drug-Induced Skin Eruption
• Medication-Induced Skin Eruption

What is Drug-Induced Eruption of Skin? (Definition/Background Information)

• Drug-Induced Eruption of Skin is condition that develops as an adverse reaction to a medication. It is not contagious and it cannot be transmitted from one individual to another
• The cause of Drug-Induced Eruption of Skin in most cases is an allergy to medication, or a drug intolerance. The onset of the condition can occur at any age
• It can affect both men and women; although, women are more likely to be diagnosed with Drug-Induced Skin Eruption, as they are at a higher risk for developing an allergic reaction
• The condition usually results in red bumps appearing all over the skin, swelling of the tongue, and swelling under the larynx (angioedema). It may also result in enlarged lymph nodes (or lymphadenopathy), which may be a serious condition
• Drug-Induced Eruption of Skin is usually diagnosed by a thorough clinical history and physical examination, as well a blood test and skin prick testing. Treatment measures include immediately discontinuing the use of medication causing the skin eruptions, and the use of steroids and antihistamines
• Stopping the usage of the offending medication usually results in the disappearance of the skin lesions. Hence, the prognosis of Drug-Induced Eruption of Skin is generally excellent with no known major complications being noted

A special subset of these eruptions is DRESS syndrome or Drug Reaction with Eosinophilia and Systemic Symptoms syndrome. It is a drug-induced hypersensitivity syndrome (DIHS) with rash, fever, swollen lymph nodes, high eosinophil count, low platelets, and increased atypical lymphocytes. The internal organs are also involved. This syndrome is a potentially fatal condition.

Who gets Drug-Induced Eruption of Skin? (Age and Sex Distribution)

• The onset of Drug-Induced Eruption of Skin can occur at any age. Both children and adults may be affected
• Generally, for some unknown reasons, women seem to be at a higher risk of developing an allergic reaction to a drug, than men
• All races and ethnicities are known to be affected

What are the Risk Factors for Drug-Induced Eruption of Skin? (Predisposing Factors)

The following are risk factors for Drug-Induced Eruption of Skin:

• Previous allergic reactions to drugs or drug intolerance: Generally, the more the drugs are taken, the higher is the likelihood for an allergic reaction
• Cross-reactions between medication, food, sunscreens, and cosmetics
• Presence of underlying viral infections
• Genetic factors that affect an individual’s ability to metabolize medication

It is important to note that having a risk factor does not mean that one will get the condition, A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Drug-Induced Eruption of Skin? (Etiology)

There are a few known causes of Drug-Induced Eruption of Skin:

• Neurological symptoms due to brain tumors, which may include:
  • An immediate allergic reaction to medication can occur within an hour of exposure/ingestion of the medication
  • Delayed allergic reactions can occur at some point between 6 hours to several weeks after the first encounter
• Drug intolerance; typically related to an issue with the dose provided
• Predictable reactions or side effects, that are known to be associated with the medication

What are the Signs and Symptoms of Drug-Induced Eruption of Skin?

The signs and symptoms associated with Drug-Induced Eruption of Skin may include:

• Red bumps appearing over the skin
• Erosion of the mucus membrane
• Swelling under the skin (angioedema) and swelling of the tongue
• Enlarged lymph nodes (lymphadenopathy)
• Blisters on the skin
• High fever
• Difficulty breathing (dyspnea)
• Low blood pressure (hypotension)

How is Drug-Induced Eruption of Skin Diagnosed?

Drug-Induced Eruption of Skin is diagnosed in the following manner:

• A complete physical examination and a thorough evaluation of the individual’s medical history. The healthcare provider may assess the following in order to diagnose Drug-Induced Skin Eruption:
  • If there is a period of time between introduction of the drug and onset of skin eruptions
  • How the drug is administered, the dose, the duration, and frequency of drug administration
  • If there is any improvement after drug withdrawal and any reaction upon re-administration
• Neurological symptoms due to brain tumors, which may include:
  • When the symptoms began and whether they are becoming worse
  • List of prescription and over-the-counter medications currently being taken
  • About one’s personal and family history of cancer, diabetes, thyroid gland, ovarian, and adrenal gland abnormalities, etc.
• The following examinations may be undertaken to aid in the diagnosis of Drug-Induced Eruption of Skin:
  • Complete blood count (CBC)
  • Serum chemistry studies to check for electrolyte balance, renal and/or hepatic function
  • Antibody tests
  • Direct cultures of skin eruptions to test for a primary or secondary infection
  • Urinalysis, stool guaiac tests, and chest radiography for inflammation of the blood vessels (vasculitis)
• Skin biopsy of the affected area: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Note: A skin biopsy is often performed when the diagnosis is questionable, or if it resembles other similar skin conditions.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the Possible Complications of Drug-Induced Eruption of Skin?

The potential complications due to Drug-Induced Eruption of Skin include:

• Low self-esteem due to cosmetic concerns
• Chronic pain due to swelling under the skin, blisters, mucus membrane erosions, and enlarged lymph nodes
• Dizziness or lightheadedness due to low blood pressure
• Breathing problems from the dyspnea
• Hypothyroidism and diabetes may develop in individuals who experience hypersensitivity to medication

How is Drug-Induced Eruption of Skin Treated?

The treatment measures for Drug-Induced Eruption of Skin may include the following:

• The primary treatment plan is to remove (stop usage of) the medication that caused the Drug-Induced Eruption of Skin
• Other treatment plans are considered to control the symptoms. These include first-generation antihistamines, mild topical steroids, and lotions, which help in combating the symptoms

How can Drug-Induced Eruption of Skin be Prevented?

The following actions can help prevent Drug-Induced Eruption of Skin:

• Remaining alert to previous drug allergies
• Limiting exposure to antibiotics as they are responsible for the most serious cases of Drug-Induced Eruption of Skin

What is the Prognosis of Drug-Induced Eruption of Skin? (Outcomes/Resolutions)

• The prognosis of Drug-Induced Eruption of Skin is excellent and major complications are generally not observed
• Most individuals can be fully treated by removing the offending drug/medication causing Drug-Induced Skin Eruption
• In some cases, individuals can tolerate re-exposure to the medication, if:
  • The original symptoms were not the result of the drug in question being prescribed
  • The individual's drug-sensitivity reduces over time
  • The underlying illness that caused the reaction has cleared up

Additional and Relevant Useful Information for Drug-Induced Eruption of Skin:

• On an average, up to 2% of new prescription medications are known to cause Drug-Induced Eruption of Skin
• Most skin eruptions caused by drugs are benign, but a small percentage of the cases can be life-threatening and may require admission into a hospital