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