Cutaneous drug reactions

Introduction

Cutaneous drug reactions occur when your skin has a reaction to a drug you are taking. A red, itchy rash and hives are the most common reactions; however, there are many different types, and some can be life threatening. Drugs that most frequently cause problems include sulfa drugs, antibiotics such as penicillins and tetracyclines, and phenytoin (Dilantin, a drug that prevents convulsions). Other drugs can also cause adverse reactions. Symptoms typically occur within 2 weeks of starting a medication.

Signs and Symptoms

  • Red, itchy rash, or blotches
  • Hives
  • Acne-like eruptions
  • Pigmentation changes (may appear as brown or gray blotches)
  • Dry, cracked skin, as in eczema
  • Peeling skin
  • Tissue death (necrosis)

What Causes It?

The following drugs might cause cutaneous reactions:

  • Allopurinol (gout medication)
  • Antibiotics (penicillins, tetracyclines)
  • Aspirin
  • Barbiturates
  • Chemotherapeutic agents (cancer treatments)
  • Cortisones and other corticosteroids
  • Diuretics (water pills)
  • Heavy metals (gold, copper)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Phenothiazines (used to treat serious mental conditions)

What to Expect at Your Provider's Office

Your doctor will examine your skin, mouth, and throat. You should make a list of all the drugs (prescription, nonprescription, and illegal) and herbal and vitamin supplements you've taken over the last 4 weeks. Your doctor may have you stop taking the suspected drug and prescribe something else.

Treatment Options

The treatment depends on the type of reaction you are having and how serious it is. Symptoms will often disappear once you stop taking the suspected drug or take it at a lower dosage. However, you may need treatment to recover. Your health care provider may prescribe drugs to help stop the reaction, such as epinephrines, corticosteroids, antihistamines, or topical ointments. If you also have life threatening symptoms, such as trouble breathing, you will be hospitalized until you are stable.

Because the kind of treatment you need depends on the type of skin reaction you are having, it's important to see your doctor and not self-treat for any adverse drug reactions. If you suspect a drug is causing an adverse reaction, talk to your doctor immediately before stopping the drug.

Drug Therapies

  • Corticosteroids (applied topically, or taken orally or intravenously), such as prednisone
  • Antihistamines
  • Anti pruritic treatments (to stop itching)
  • Epinephrine, for severe respiratory/cardiovascular implications
  • Topical lotions or ointments: for itching, lesions, and other inflammatory skin reactions
  • Baths (with or without additives)
  • Special treatments: for severe reactions (depending upon severity)

Surgical Procedures

Surgical removal of dead tissue may be necessary in very severe reactions.

Complementary and Alternative Therapies

Some cutaneous drug reactions may be life threatening and need immediate medical attention. Mild reactions may be safely and effectively treated with alternative therapies. However, talk to your doctor before using any therapy, as you will need to adjust the type of drug or the dose of the drug that caused the initial reaction. You should notify your doctor when any kind of drug reaction occurs. Keep in mind that a cutaneous drug reaction that occurs the first time you take a drug may cause an even more severe reaction the next time you take that drug. It’s important to keep a record of any drugs that cause reactions when you take them.

Some alternative treatments may cause allergic reactions of their own, so it's important to follow the directions of your doctor before starting any treatment. The following are some natural therapies, which, when used under a doctor's supervision for a short period of time (3 -7) days, may promote healing.

Nutrition

  • Vitamin C (1,000 mg 2 - 6 times per day in adults for short periods) helps skin heal. Some studies suggest that vitamin C can lower histamine levels (which cause hives). Lower dose if diarrhea develops.
  • B-complex with extra B12 (1,000 mcg per day) aids in skin health. Vitamin B12 injections have helped reduce the severity of hives, but it isn't clear whether taking B12 orally has the same effect. Vitamin B5 or pantothenic acid (5 - 10 mg per day) helps heal wounds.
  • Vitamin E (400 - 800 IU per day) and zinc (30 mg per day) help skin heal. Both are also sometimes applied topically.
  • Bromelain (250 mg 2 - 3 times per day, taken between meals), an enzyme derived from pineapple, reduces inflammation. Avoid if you take blood-thinning medicines. Bromelain can interfere with certain antibiotics and can slow blood clotting.
  • Omega-3 fatty acids, such as those found in fish oil (1 g per day), help maintain skin health and may have anti-inflammatory properties. If you take blood thinning medication, talk to your doctor before taking omega-3 fatty acids.
  • Rutin (500 mg 2 times per day) or quercetin (up to 1,000 mg 3 times per day) may improve skin health.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs only under the supervision of a health care provider. Always tell your doctor about any herbs you may be taking.

Talk to your doctor to find out which treatments are best for your particular skin condition.

Applied topically

Some of the following herbs also can be combined into a poultice or skin wash, avoid contact with the eyes, mouth, and nose:

  • Aloe (Aloe vera), as a cream or gel.
  • Agrimony (Agrimonia eupatoria or procera), an astringent, applied as a poultice. Boil 1 tsp. dried herb in one cup water for 5 - 10 minutes. Cool and apply to a clean, soft cloth and place on affected area.
  • Calendula (Calendulaofficinalis), or marigold, as an ointment or a tea applied topically. To make tea from tincture, use 1/2 to 1 tsp. diluted in 1/4 cup water. Test skin first for any allergic reaction.
  • Marshmallow (Althaeaofficinalis) as a topical ointment to help wounds heal and fight inflammation.
  • Tea tree oil (Melaleuca alternifolia) as a commercially prepared formula of oil or cream. Apply two times per day to reduce inflammation.
  • Astragalus (Astragalus membranaceus) as an ointment containing 10% of the herb.
  • Burdock (Arctium lappa) as a compress. Use 1 tsp. herb in one cup boiling water. Cool and apply to clean, soft cloth. Place on affected area.
  • Chamomile (Matricaria recutita) as an ointment containing 10% of the herb, or as a tea applied topically, to reduce itching. To make tea, boil 3 g of herb in one cup water. Cool and apply to a clean, soft cloth. Place on affected area.
  • Gotu kola (Centella asiatica) as a cream containing 1% of the herb, to help heal wounds.
  • Echinacea or coneflower (Echinacea angustifolia or purpurea) as a gel or ointment containing 15% of the juice of the herb.
  • Slippery elm bark (Ulmus rubra or fulva) as a poultice. Mix 1 tsp. dried powder in one cup boiling water. Cool and apply to a clean, soft cloth. Place on affected area.

To relieve itching and help skin heal, you can combine chamomile with marigold or echinacea.

For further skin relief, add powdered oatmeal (or 1 cup of oatmeal in a sock) to a lukewarm bath.

Taken orally

  • Evening primrose oil (Oenothera biennis) may help fight skin inflammation. Do not take evening primrose oil if you take blood-thinning medication or if you have a history of seizures.
  • Pycnogenel (Pinus pinaster), an extract of the bark of a particular type of pine tree, helps promote skin health.
  • Thyme (Thymus vulgaris). Do not take thyme if you take blood-thinning medication. Never take oil of thyme, which can be toxic.
  • Burdock (Arctium lappa) is an anti-inflammatory and antioxidant. Do not take burdock if you have diabetes, or if you take blood thinning medication or a diuretic (water pills).
  • Gotu kola (Centella asiatica) helps improve skin health. Do not take gotu kola if you have high blood pressure or experience anxiety.
  • Cat's claw (Uncaria tomentosa) has anti-inflammatory and antioxidant effects. Cat's claw my possibly worsen autoimmune disorders and leukemia, and it may interaction with several medications. Do not take cat's claw if you have high blood pressure or take blood thinning medication.

Homeopathy

Homeopathic remedies can be used to improve symptoms of itching, burning, and swelling. While few studies have examined the effectiveness of specific homeopathic remedies, professional homeopaths may recommend one or more of the following treatments for cutaneous drug reactions based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

  • Apis mellifica -- for red rashes accompanied by hives, swelling, itching, and stinging sensations. Symptoms are relieved by cold applications. This remedy is most appropriate for individuals who tend to be very tired.
  • Bryonia -- for fine, dry bumps concentrated on the face. Symptoms worsen with movement. This remedy is most appropriate for individuals who are irritable.
  • Croton tiglium -- for inflamed, itchy skin that is tender to touch. Rash is often concentrated around the scalp, eyes, or genitals.
  • Graphites -- for rashes that may be cracking and even oozing liquid. Rashes that improve with graphites are often accompanied by chills and a burning sensation. Symptoms worsen with both warmth and cold, and in damp weather.
  • Ledum -- for severely inflamed rashes that worsen at night and improve with cool compresses.
  • Rhus toxicodendron -- for burning and itching that are relieved by hot applications. This remedy is most appropriate for individuals who are generally restless and irritable.
  • Sepia -- for a dry, brownish red rash with tiny raised lesions.
  • Sulphur -- for red, itchy rashes that worsen at night or when exposed to heat. This remedy is most appropriate for individuals who crave cold drinks and may be inactive and irritable.
  • Urtica urens -- for itchy, burning rashes that worsen with cold air.

Acupuncture

Acupuncture can help reduce itching and inflammation of the skin. Most treatments will focus on “cooling surface heat."

Following Up

It is important to stay in touch with your health care provider until the reaction is completely cleared up. If you have severe reactions, wear medical alert jewelry stating what drugs you are allergic to.

Special Considerations

If you have any questions about any drug -- whether it is prescribed by your doctor or purchased over the counter -- ask your pharmacist or health care provider.

Supporting Research

Bae EA, Han MJ, Shin YW, Kim DH. Inhibitory effects of Korean red ginseng and its genuine constituents ginsenosides Rg3, Rf, and Rh2 in mouse passive cutaneous anaphylaxis reaction and contact dermatitis models. Biol Pharm Bull. 2006 Sep;29(9):1862-7.

Brinkhaus B, Lindner M, Schuppan D, Hahn EG. Chemical, pharmacological and clinical profile of the east Asian medical plant Centella asiatica. Phytomedicine. 2000;7:427-48.

Habif. Clinical Dermatology. 5th ed. Philadelphia, PA: Mosby, An Imprint of Elsevier; 2009.

Koh KJ, Pearce AL, Marshman G, et al. Tea tree oil reduces histamine-induced skin inflammation. Br J Dermatol 2002;147:1212-7.

Mao SP, Cheng KL, Zhou YF. Modulatory effect of Astragalus membranaceus on Th1/Th2 cytokine in patients with herpes simplex keratitis. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2004 Feb;24(2):121-3.

Musette P, Kaufman JM, Rizzoli R, Cacoub P, Brandi ML, Reginster JV. Cutaneous side effects of antiosteoporosis treatments.Ther Adv in Musc Dis.2011; 3(1):21-41.

Newell BD. Pediatr Ann.2010 Oct;39(10):618-25.

Sassolas B, Duong TA. Dermatology and the effects of medication on the skin. Soins.2010 Sep;(748):42-4.

Shin YW, Bae EA, Lee B, Lee SH, Kim JA, Kim YS, Kim DH. In vitro and in vivo antiallergic effects of Glycyrrhiza glabra and its components. Planta Med. 2007 Mar;73(3):257-61.

Alternative Names

Drug reactions - cutaneous; Skin disorders - drug reactions

Version Info

  • Last Reviewed on 03/02/2012
  • Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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This page was last updated: May 31, 2013

         
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