Management of Acute Cutaneous Drug Reactions
See figure 1 for image of an acute cutaneous drug reaction.
Common offending medications
- Antibacterials: penicillins, cephalosporins and fluoroquinolones
- Sulphonamide antibacterials: sulfamethoxazole, trimethoprim, co-trimoxazole
- Other sulphonamides: sulfasalazine, dapsone, sulfonylureas, furosemide
- Aromatic antiepileptic drugs: carbamazepine, phenytoin, lamotrigine
- Diuretics e.g. furosemide, bumetanide, thiazides
- Antifungal medications: terbinafine
The offending drug should be stopped as soon as possible. Below are the treatment options for managing acute cutaneous drug reactions.
Prescribe regular emollients four times a day. Examples include: Epimax Original®, Zerobase®, liquid and white soft paraffin. See GGC Adult Medicines Formulary for preferred choice. Important points when prescribing:
- Avoid aqueous cream.
- In general, ointments are preferred for dry skin but are poorly tolerated.
- Creams and lotions are used on less dry skin and better tolerated.
Prescribe a course of topical corticosteroids once a day / twice a day for 7 days.
- Face: 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 local dermatology team
- The majority of cutaneous drug reactions do not require dermatology input. Consider referral if severe skin blistering 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 updated: September 2022
Page updated: September 2022