|Cutaneous Drug Reactions
|Also Listed As:
|| Drug Reactions, Cutaneous; Skin
Disorders, 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
- Acne-like eruptions
- Pigmentation changes (may appear as brown or gray
- Dry, cracked skin, as in eczema
- Peeling skin
- Tissue death (necrosis)
|What Causes It?|
Some drugs that might cause cutaneous reactions include the
- Allopurinol (gout medication)
- Antibiotics (penicillins, tetracyclines)
- 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
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.
- 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
- 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
- Topical lotions or ointments: for itching, lesions, and other
inflammatory skin reactions
- Baths (with or without additives)
- Special treatments: for severe reactions (depending upon
- Antacids in some cases
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.
- 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
- Vitamin E (400 to 800 IU per day) improves circulation to your
- Zinc (30 to 50 mg per day) supports the immune system.
- Bromelain (125 to 250 mg two to three times per day) reduces
- Magnesium (400 to 800 mg per day) may help prevent spasms in the
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
- Turmeric (Curcuma longa, 100 mg two to three times per
- Quercetin (up to 1,000 mg three times per day)
- Hesperidin (200 mg three to four times per
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
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
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.
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
- 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,
- 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
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
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
American Academy of Dermatology. Guidelines of care for cutaneous adverse
drug reactions. J Am Acad Dermatol. 1996;35:458-461. Available at
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.
Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines.
3rd 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.
Johnston CS. Recommendations for vitamin C intake. JAMA.
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.
|Review Date: August 1999|
|Reviewed By: Participants in the review process include: Robert A. Anderson, MD, President
, American Board of Holistic Medicine, East Wenatchee, WA; Constance Grauds,
RPh, President, Association of Natural Medicine Pharmacists, San Rafael, CA;
Richard A. Lippin, MD, President, The Lippin Group, Southampton, PA; Leonard
Wisneski, MD, FACP, George Washington University, Rockville,
Copyright © 2004 A.D.A.M., Inc
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