Cutaneous Drug Reactions

Cutaneous drug reactions are adverse responses to drugs that appear on the skin. A red, itchy rash and hives are the most common reactions; however, there are many different types, and some are life-threatening. Drugs that most frequently cause problems include sulfa drugs, antibiotics such as penicillins and tetracyclines, and phenytoin (a drug that prevents convulsions).

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?

Some drugs that might cause cutaneous reactions include the following.

• Allopurinol (gout medication)
• Antibiotics (penicillins, tetracyclines)
• Aspirin
• Barbiturates
• Chemotherapeutic agents (cancer treatments)
• Cortisones and other steroids
• Diuretics (water pills)
• Heavy metals (gold, copper)
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Phenothiazines (sedatives)

What to Expect at Your Provider's Office

Your health care provider 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 four weeks. Your provider may have you stop taking the suspected drug and prescribe something else.

Treatment Options

Choice of 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; 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.

Drug Therapies

• Corticosteroids (systemic/intravenous): for anaphylaxis, severe hives, and other allergic skin reactions—prednisone 40 to 60 mg/day, 5 to 10 days
• Corticosteroids (topical): for limited eczema and inflammatory skin lesions
• Antihistamines: for itching—diphenhydramine 25 to 50 mg every six hours; hydroxyzine 10 to 25 mg every six to eight hours; for anaphylaxis/widespread hives—epinephrine (0.01 ml/kg to 0.3 ml max.)
• 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)
• Antacids in some cases

Surgical Procedures

Surgical removal of dead tissue in severe reactions

Complementary and Alternative Therapies

Some cutaneous drug reactions may be life-threatening and need immediate medical attention. Mild to moderate reactions may be safely and effectively treated with alternative therapies. Nutrition

• Vitamin C (250 to 500 mg two times per day) stabilizes certain types of skin cells and stops reactions.
• B-complex with extra B12 (1,000 mcg per day) aids in skin health.
• Vitamin E (400 to 800 IU per day) improves circulation to your skin.
• Zinc (30 to 50 mg per day) supports the immune system.
• Bromelain (125 to 250 mg two to three times per day) reduces inflammation.
• Magnesium (400 to 800 mg per day) may help prevent spasms in the bronchial passages.

Herbs
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. Tinctures may be used singly or in combination as noted.

• Turmeric (Curcuma longa, 100 mg two to three times per day)
• Quercetin (up to 1,000 mg three times per day)
• Hesperidin (200 mg three to four times per day)

An infusion of equal parts of coneflower (Echinacea augustifolia), yarrow (Achillea millefolium), chamomile (Matricaria recutita), peppermint (Mentha piperita), and red clover (Trifolium pratense) will strengthen your immune system, reduce swelling, and help with lymph drainage (fluid that is part of immune system).

To relieve itching, use one or more of the following herbs brewed as a tea to make a skin wash (1 tsp. of herb per cup of water): peppermint, chickweed (Stellaria media), or chamomile (Matricaria recutita). Be sure the tea is cool, and apply to the affected area as needed. To help your skin heal, add one or more of the following: marigold (Calendula officinalis), comfrey (Symphytum officinale), or coneflower (Echinacea angustifolia).

For open sores use powdered slippery elm (Ulmus fulva), goldenseal (Hydrastis canadensis), and marshmallow root (Althaea officinalis). Add enough skin wash to make a paste. Apply to affected area as needed.

Aloe vera gel applied to your skin can soothe burning and reduce swelling. For further skin relief, add powdered oatmeal (or 1 cup of oatmeal in a sock) to a lukewarm bath. Or, make a skin balm from flaxseed oil (2 tbsp.) plain or with 5 drops of oil of chamomile or marigold.

Homeopathy

Some cutaneous drug reactions are life-threatening and require immediate medical attention. Homeopathic remedies can be used to improve symptoms of itching, burning, and swelling. While there have been few studies examining 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. In homeopathic terms, a person's constitution is his or her 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, and/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, 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 are worsened at night or by warmth; this remedy is most appropriate for individuals who crave cold drinks and may be lazy and irritable
• Urtica urens — for itchy, burning rashes that worsen with cold air

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 health care provider or purchased over the counter—ask your pharmacist or health care provider.

References

Adverse cutaneous reaction. NIH. Accessed at https://www.ncbi.nlm.nih.gov/ on June 6, 2018.

American Academy of Dermatology. Guidelines of care for cutaneous adverse drug reactions. J Am Acad Dermatol. 1996;35:458-461. Available at http://www.aad.org/.

Antibiotics. NMIHI. Accessed at http://drugs.nmihi.com/antibiotics.htm on June 6, 2018.

Balch JF, Balch PA. Prescription for Nutritional Healing. 2nd ed. Garden City Park, NY: Avery Publishing Group; 1997.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Corticosteroids. NMIHI. Accessed at http://drugs.nmihi.com/corticosteroids.htm on June 6, 2018.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3^rd ed. New York, NY: Penguin Putnam; 1997: 226-227, 319-320.

Dambro MR, ed. Griffith's 5 Minute Clinical Consult. Baltimore, Md: Lippincott, Williams & Wilkins; 1998.

Fauci AS, Braunwald E, Isselbacher KJ, et al,, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Furosemide. NMIHI. Accessed at http://www.nmihi.com/f/furosemide.html on June 6, 2018.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 255-265.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993.

Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin, Calif: Prima Publishing; 1998.