Management of Acute Cutaneous Drug Reactions

See figure 1 for images of an acute cutaneous drug reaction.

Common offending medications

  • Antibacterials: penicillins, cephalosporins and fluoroquinolones
  • Sulphonamides
    • Sulphonamide antibacterials: sulfamethoxazole, trimethoprim, co-trimoxazole
    • Other sulphonamides: sulfasalazine, dapsone, sulfonylureas, furosemide
  • Aromatic antiepileptic drugs: carbamazepine, phenytoin, lamotrigine
  • Allopurinol
  • NSAIDs
  • Diuretics e.g. furosemide, bumetanide, thiazides
  • Antifungal medications: terbinafine

Treatment options

The offending drug should be stopped as soon as possible. Below are the treatment options for managing acute cutaneous drug reactions.

Important points when prescribing topical treatments:

  • In general, ointments are preferred for dry skin but are poorly tolerated.
  • Creams are used on less dry skin and better tolerated.

Prescribe regular emollients up to four times a day. Examples include: Hydromol® ointment, Zerobase® cream, QV® cream, white soft paraffin 50% / liquid paraffin 50% ointment (avoid aqueous cream).

Prescribe a course of topical corticosteroids once a day / twice a day for 7 days.

  • Face: hydrocortisone 1% or if severe, clobetasone butyrate 0.05% (Eumovate®)
  • Trunk and limbs: betamethasone valerate 0.1% (Betnovate®), mometasone furoate 0.1% (Elocon®)
  • Palms and soles: clobetasol proprionate 0.05% (Dermovate®)

Refer to dermatology team

  • The majority of cutaneous drug reactions do not require dermatology input. Consider referral if there is a florid, widespread eruption, any skin blistering / mucosal involvement is present or rapidly progressive changes occur.
  • Dermatology will advise if a skin biopsy is required in severe cases e.g. suspected toxic epidermal necrolysis (TEN).

 

Guideline reviewed October 2023
Page updated November 2023



;