Basic Reactions

Acneiform eruption

Glucocorticoids, anabolic steroids, contraceptives, halogens, isoniazid, lithium, azathioprine, danazol, Epidermal Growth Factor Receptor (EGFR) Inhibitors

Mimics acne. See Section 1 and Pustular Eruptions. May not need to stop offending agent

Bullous eruptions

Naproxen, nalidixic acid, furosemide, oxaprozin, penicillamine, piroxicam, tetracyclines, ACE inhibitors, sulfasalazine, lithium, IL-2, vancomycin

Vildagliptin (and other DPP4 inhibitors)

Mimics fixed drug eruption, drug-induced vasculitis, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), porphyria, pseudoporphyria, drug-induced pemphigus, drug-induced pemphigoid, drug-induced linear IgA disease, bullae over pressure areas in sedated patients

Dermatomyositis-like reactions

Penicillamine, NSAIDs, carbamazepine, hydroxyurea

Mimics dermatomyositis. See Section 14

Drug hypersensitivity syndrome

Antiepileptic drugs, sulfonamides, and others

Mimics exanthematous reactions; systemic involvement (see Drug Hypersensitivity Syndrome)

Eczematous eruptions

Ethylenediamine, antihistamines, furosemide, lithium, thiazides, aminophylline/aminophylline suppositories; procaine/benzocaine; iodides, iodinated organic compounds, radiographic contrast media/iodine; streptomycin, kanamycin, paromomycin, gentamicin/neomycin sulfate, cephalosporins, penicillin; nitroglycerin tablets/nitroglycerin ointment; disulfiram/thiuram, allopurinol, barbiturates, captopril, carbamazepine, phenytoin, lenalidomide

Systemic administration of a drug to an individual who has been previously sensitized to the drug by topical application can provoke a widespread eczematous dermatitis (systemic contact-type dermatitis, see Section 2) or urticaria

Erythema multiforme, SJS, TEN

Anticonvulsants, sulfonamides, allopurinol, NSAIDs (piroxicam)

See Sections 8 and 14

Erythema nodosum

Sulfonamides, other antimicrobial agents, analgesics, oral contraceptives, granulocyte colony-stimulating factor (G-CSF)

See Section 7

Exfoliative dermatitis and erythroderma

Sulfonamides, antimalarials, phenytoin, penicillin

See Section 8

Lichenoid eruptions (resemble lichen planus)

Gold, β-blockers, ACE inhibitors, especially captopril; antimalarials, thiazide diuretics, furosemide, spironolactone, penicillamine, calcium-channel blockers, carbamazepine, lithium, sulfonylurea, allopurinol, interferon alpha, methyldopa, phenytoin, proton pump inhibitors, sulphonylureas

See Section 14

May be extensive, occurring weeks to months after initiation of drug therapy; may progress to exfoliative dermatitis

Adnexal involvement may result in alopecia, anhidrosis

Resolution after discontinuation slow, 1-4 months; up to 24 months after gold

Lupus erythematosus (LE)

These agents induce Systemic Lupus Erythematosus Procainamide, hydralazine, isoniazid, minocycline, acebutolol, Ca²⁺ channel blockers, ACE inhibitors, docetaxel, capecitabine, gemcitabine

Penicillin, Griseofulvin, Terbinafine, Proton pump inhibitors, Diltiazem, Nifedipine, Hydrochlorthiazide, Metoprolol, Buproprion, Statins, Anti-malarial

See Section 14

5% of cases of systemic LE are drug-induced

Cutaneous manifestations, including photosensitivity; however, urticaria, erythema multiforme-like lesions, Raynaud phenomenon are not common

Necrosis

Warfarin, heparin, interferon-α, cytotoxic agents

See ACDR-Related Necrosis

Photosensitivity

See Tables 10-4, 10-5, 10-6

See Section 10

Phototoxic, photoallergic, or photocontact

Pigmentary disorders

Amiodarone, minocycline, antimalarials, cytotoxic agents, gold, oral contraceptives, phenytoin, fluorouracil, busulfan (tan), doxorubicin (only with liposomal formulation), bleomycin (flagellate), ifosfamide, mitoxantrone,

See Drug-Induced Pigmentation

Pityriasis rosea-like eruptions

Gold, captopril, imatinib, and others

For clinical appearance, see Section 3

Pseudolymphoma

Phenytoin, carbamazepine, allopurinol, antidepressants, phenothiazines, benzodiazepine, antihistamines, beta-blockers, lipid-lowering agents, cyclosporine, D-penicillamine

Papular eruptions with a histology mimicking lymphoma

Pseudoporphyria

Tetracycline, furosemide, naproxen

See Section 10 and Pseudoporphyria

Psoriasiform eruption

Antimalarials, beta-blockers, lithium salts, NSAIDs, interferon, penicillamine, methyldopa, hydroxychloroquine, digoxin

See Section 3

Purpura

Penicillin, sulfonamides, quinine, isoniazid

See Section 20

Hemorrhage into morbilliform ACDR occurs not uncommonly on the legs

Progressive pigmented purpura also reported associated with drugs (see Section 14)

Pustular eruptions

Ampicillin, amoxicillin, macrolides, tetracyclines, beta-blockers, Ca²⁺ channel blockers

EGFR inhibitors (Fig. 23-4)

Acute generalized exanthematous pustulosis (AGEP, Pustular Eruptions)

Must be differentiated from pustular psoriasis; eosinophil in the infiltrate suggests AGEP

Scleroderma-like reactions

Penicillamine, bleomycin, bromocriptine, Na-valproate, 5-hydroxytryptophan, docetaxel, gemcitabine, acetanilide-containing rapeseed cooking oil

See Section 14

Sweet syndrome

All-trans retinoic acid, contraceptives, G-CSF, granulocyte-macrophage CSF (GM-CSF), minocycline, imatinib, trimethoprim-sulfamethoxazole

See Section 7

Vasculitis

Propylthiouracil, hydralazine, G-CSF, GM-CSF, allopurinol, cefaclor, minocycline, penicillamine, phenytoin, isotretinoin, aspirin, erythromycin, furosemide, interferon, methotrexate, NSAIDs, sulfasalazine, sulfonamide, thiazides

See Section 14