George Woodbury MD 3/6/2023
What is a Drug Eruption?
A Drug Eruption is a term used by Dermatologists for a reaction to a medication producing a rash. There are several different types of rashes that can result from medication use, including what’s called a moribilliform drug rash (measles-like), with many itchy bumps all over the body; an allergic-type rash called Erythema Multiforme; and a more severe eruption called Stevens-Johnson Syndrome, which can even turn into what’s called Toxic Epidermal Necrolysis.
What type of testing can help patients with possible Drug Eruptions?
Dermatologists such as myself generally consider one of about three types of tests to evaluate possible Drug Eruption. First, sometimes we do a skin biopsy or skin excision to look for whether a given case is actually a Drug Eruption, or whether it may be another type of skin condition, such as Dermatitis Herpetiformis (which is due to a sensitivity to wheat gluten), or even possibly an autoimmune condition such as Lupus.
Secondly, Dermatologists sometimes do a scraping for a Fungal Culture test or a KOH test to evaluate whether a yeast of fungal organism is causing a true skin infection. The results of a Fungal culture take a full month, so we sometimes start treatment before we have this test result back from the laboratory. The results of a KOH test take only a few minutes.
Thirdly, a third type of testing – Allergy Patch Testing – can be quite helpful in evaluating for causes of possible Drug Eruptions or possible Allergic Contact Dermatitis. In my Memphis Dermatology practice, at Rheumatology and Dermatology, I have been offering Allergy Patch Testing since 2004. I am also a member of the American Contact Dermatitis Society, an 1100 Dermatologist organization focused on this type of testing that meets at least once a year to discuss updates on the panels of chemicals to which we offer testing. For instance, the 2023 yearly meeting, of which I was an attendee, was over a da,in New Orleans, Louisiana, attended by over 100 Dermatologists focusing on Contact Dermatitis, from all over the world. For more on Allergy Patch Testing, see the topic Allergy Patch Testing on this same web site: https://www.Rheumderm.com.
What medications are at highest risk of causing Drug Eruptions?
Generally, a drug causing a rash is one that the patient started within six to eight weeks prior to the start of the rash. Remember that Drug Eruptions can be caused by classic medications, in the sense of a chemical that affects the body in a specific way, but also by over-the-counter herbs and supplements, like Echinacia and Gingko. “Drug” Eruptions can even be caused by spices or foods that one has recently started taking. A Dermatologist must act like a type of detective to effectively sort out what the culprit “drug” is, particularly if a number of different medications are in the picture. It helps for patients to actually bring the medications being taken to a Dermatology appointment, particularly with a chart of how long each medication has been taken.
High on the list of culprit drugs are anticonvulsant medications such as Dilantin, lamotrigine, gout medications such as allopurinol, nonsteroidal medications (NSAIDs) like diclofenac, and certain antibiotics, namely sulfa drugs including trimethoprim-sulfa DS and penicillins. But pretty much every medication has been reported as causing Drug Eruptions. So the time course of when each medication in the list was started – vis-à-vis the start of the rash – helps Dermatologists to sort out whether it is the probably cause of the rash. Sometimes we even have to stop that medication – with of course proper permission of the doctor that started that medication – then check whether the rash or eruption comes back when the medication is restarted.
What treatment options tend to be helpful for patients with Drug Eruptions?
Dermatologists often consider either oral steroid tablets (called prednisone or methylprednisolone tablets) or a steroid shot (called a Medrol Shot) for patients with severe reactions. We also commonly consider one of about sixty “topical steroid creams or ointments,” meaning prescription medicines for use “on top of” or “superimposed upon” the skin. These include Clobetasol, Halobetasol, Diflorasone diacetate, and Betamethasone dipropionate cream. These topical steroids are available as creams, ointments, foams, sprays, gels, and many other types of preparations, depending upon what type of substance the medicine is put into – what type of “vehicle” is involved. So Dermatologists such as myself work to develop a ‘care plan’ that uses the most appropriate prescription product to match the condition that our patients are suffering from.
A Memphis Dermatologist like myself will also often consider a one to two weeks or more course of an oral steroid medicine called prednisone, or sometimes a steroid shot, called a Medrol shot. We also often use courses of oral antihistamine tablets or capsules, which tend to help to alleviate itching, such as hydroxyzine, cyproheptadine, fexofenadine, or loratadine.
Can the office recommend any cosmetics or toiletry products if I am found to have reactions to certain chemicals?
In addition to being a Cordova Dermatologist, I am the President of Big River Silk™ Skincare, focused on skincare products with lower risk of allergies for people of all ages, from babies to seniors, using a minimal number of chemicals, to minimize the risk of allergic reactions. We offer HypoShea Moisturizer Cream, free of fragrances, dyes, and propylene glycol, as well as HypoShea Oil, convenient for use after bathing or showering (1 oz: $7.97/2 oz: $12.95), and also a new preparation as of 2022: HypoShea Moisturizer Lotion, which is less moisturizing and also fragrance-free. All Big River Silk Skincare products are available in 1 oz: $12.95/2 oz: $18.95/4 oz: $29.95/8 oz: $39.95, on-site at our international headquarters at 8143 Walnut Grove Road, Cordova TN 38018 (1-901-753-0168). Of products can also be ordered at https://www.Bigriversilkskincare.com ($5.00 shipping and handling for orders under $40.00, otherwise free shipping and handling ($10.00 for Canadian orders under $75.00).
All products are available at www.Bigriversilkskincare.com, or at our international headquarters, at 8143 Walnut Grove Ro ad, Cordova, TN 38018, Monday-Friday, from 7:30 AM to 4:30 PM. Or you can call us at 1-901-753-0168. We do offer free shipping and handling or US orders above $40.00 ($70.00 Canadian). Otherwise, $5.00 shipping and handling for US orders/$10.00 Canadian.
If you or a friend would like to come in for a skin consultation, my Memphis Dermatology practice has been with Rheumatology and Dermatology, 8143 Walnut Grove Road, Cordova TN 38018 since 1993 (1-901-753-0168). Or you can find a Dermatologist closer to you by going to the American Academy of Dermatology website, https://www.AADA.org, then plugging your zip code into the “Find a Dermatologist” tab. Never itch in silence!