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
  • 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.

Prescribe regular emollients four times a day. Examples include: Zerobase® and 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 reviewed: November 2023

Page last updated: December 2023