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Common cutaneous drug reactions

Last reviewed: 7 Apr 2025
Last updated: 22 Nov 2024

Summary

Definition

History and exam

Key diagnostic factors

  • history of drug exposure
  • skin lesions
  • variable skin reactions within 5 to 15 minutes of drug exposure
  • variable skin reactions within a few hours of drug exposure
  • variable skin reactions within 2 weeks of drug exposure
  • variable skin reactions within months to years of drug exposure
  • previous exposure and reaction to drug
Full details

Other diagnostic factors

  • pruritus
  • associated noncutaneous features
  • pain
Full details

Risk factors

  • virus infections
  • HIV infection
  • HLA-B*5701 polymorphism
  • HLA-B*1502 polymorphism
  • HLA-B*5801 polymorphism
  • female sex
Full details

Diagnostic tests

Tests to avoid

  • immunoglobulin G (IgG) allergy testing
Full details

Tests to consider

  • blood (whole blood, plasma, serum) drug concentration
  • serum tryptase concentration (anaphylaxis)
  • complement pathway assay
  • histology of lesion biopsy
  • CBC and differential
  • antihistone antibodies to single-stranded DNA (lupus-like syndrome)
  • skin tests (prick tests, intradermal tests, patch tests)
  • drug-specific IgE
Full details

Emerging tests

  • basophil activation test
  • lymphocyte proliferation assay (LPA/LTT)
  • enzyme-linked immunospot assay (ELISPOT test)

Treatment algorithm

ACUTE

serious cutaneous adverse reactions

nonserious cutaneous adverse reactions

ONGOING

following acute episode

Contributors

Authors

Michael Ardern-Jones, BSc, MBBS, DPhil, FRCP

Associate Professor

Consultant Dermatologist

Faculty of Medicine

University of Southampton

Southampton

UK

Disclosures

MA-J declares that he has no competing interests.

Acknowledgements

Dr Michael Ardern-Jones would like to gratefully acknowledge Dr Wei Yann Haw, Dr Anne Holbrook, Dr Hermenio Lima, and Dr Jeffrey K. Aronson, the previous contributors to this topic.

Disclosures

WYH, AH and HL declare that they have no competing interests. JKA is editor of Meyler's Side Effects of Drugs and its annual companion volumes, the Side Effects of Drugs Annuals.

Peer reviewers

Shahbaz A. Janjua, MD

Specialist Dermatologist

Ayza Skin & Research Center

Lalamusa

Pakistan

Disclosures

SAJ declares that he has no competing interests.

Craig K. Svensson, Pharm.D, PhD

Dean

College of Pharmacy, Nursing, and Health Sciences

Purdue University

West Lafayette

IN

Disclosures

CKS declares that he has no competing interests.

References

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Key articles

Aronson JK, Ferner RE. Joining the DoTS: new approach to classifying adverse drug reactions. BMJ. 2003 Nov 22;327(7425):1222-5. Abstract

Gell PG, Coombs RRA, eds. Clinical aspects of immunology. 1st ed. Oxford: Blackwell; 1963.

Bigby M, Jick S, Jick H, et al. Drug-induced cutaneous reactions: a report from the Boston Collaborative Drug Surveillance Program on 15,438 consecutive inpatients, 1975 to 1982. JAMA. 1986 Dec 26;256(2):3358-63. Abstract

Kuokkanen K. Drug eruptions: a series of 464 cases in the Department of Dermatology, University of Turku, Finland, during 1966-1970. Acta Allergol. 1972 Dec;27(5):407-38. Abstract

Aronson JK, Ferner RE. Clarification of terminology in drug safety. Drug Saf. 2005;28(10):851-70. Abstract

Khan DA, Banerji A, Blumenthal KG, et al. Drug allergy: a 2022 practice parameter update. J Allergy Clin Immunol. 2022 Dec;150(6):1333-93.Full text  Abstract

Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981 Aug;30(2):239-45. Abstract

Hill AB. The environment and disease: association or causation? Proc R Soc Med. 1965 Jan;58(1):295-300.Full text  Abstract

Howick J, Glasziou P, Aronson JK. The evolution of evidence hierarchies: what can Bradford Hill's 'guidelines for causation' contribute? J R Soc Med. 2009 May;102(5):186-94.Full text  Abstract

National Institute for Health and Care Excellence. Drug allergy: diagnosis and management. September 2014 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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