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Cutaneous drug reactions

Also listed as: Drug reactions - cutaneous; Skin disorders - drug reactions

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Following Up
• Special Considerations
• Supporting Research

Cutaneous drug reactions occur when your skin has a reaction to a drug you are taking. A red, itchy rash and hives are the most common reactions; however, there are many different types, and some can be life-threatening. Drugs that most frequently cause problems include sulfa drugs, antibiotics such as penicillins and tetracyclines, and phenytoin (a drug that prevents convulsions). Other drugs can also cause adverse reactions.

Signs and Symptoms

• Red, itchy rash or blotches
• Hives
• Acne-like eruptions
• Pigmentation changes (may appear as brown or gray blotches)
• Dry, cracked skin, as in eczema
• Peeling skin
• Tissue death (necrosis)

What Causes It?

The following are some drugs that might cause cutaneous reactions:

• Allopurinol (gout medication)
• Antibiotics (penicillins, tetracyclines)
• Aspirin
• Barbiturates
• Chemotherapeutic agents (cancer treatments)
• Cortisones and other steroids
• Diuretics (water pills)
• Heavy metals (gold, copper)
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Phenothiazines (sedatives)

What to Expect at Your Provider's Office

Your health care provider will examine your skin, mouth, and throat. You should make a list of all the drugs (prescription, nonprescription, and illegal) and herbal and vitamin supplements you've taken over the last four weeks. Your provider may have you stop taking the suspected drug and prescribe something else.

Treatment Options

Choice of treatment depends on the type of reaction you are having and how serious it is. Symptoms will often disappear once you stop taking the suspected drug or take it at a lower dosage. However, you may need treatment to recover. Your health care provider may prescribe drugs to help stop the reaction, such as epinephrines, corticosteroids, antihistamines, or topical ointments. If you also have life-threatening symptoms, such as trouble breathing, you will be hospitalized until you are stable.

Because the kind of treatment you need depends on the type of skin reaction you are having, it's important to see your doctor and not self-treat for any adverse drug reactions. If you suspect a drug is causing an adverse reaction, talk to your doctor immediately before stopping the drug.

Drug Therapies

• Corticosteroids (applied topically, or taken orally or intravenously)
• Antihistamines
• Anti-pruritic treatments (to stop itching)
• Epinephrine, for severe respiratory/cardiovascular implications
• Topical lotions or ointments: for itching, lesions, and other inflammatory skin reactions
• Baths (with or without additives)
• Special treatments: for severe reactions (depending upon severity)

Surgical Procedures

Surgical removal of dead tissue may be necessary in very severe reactions.

Complementary and Alternative Therapies

Some cutaneous drug reactions may be life-threatening and need immediate medical attention. Mild to moderate reactions may be safely and effectively treated with alternative therapies. However, talk to your doctor before using any therapy, as you will need to adjust the type of drug or the dose of the drug that caused the initial reaction. Keep in mind that a cutaneous drug reaction that occurs the first time you take a drug may cause an even more severe reaction the next time you take that drug. It’s important to keep a record of any drugs that cause reactions when you take them

Some alternative treatments may cause allergic reactions of their own, so it's important to follow the directions of your health care provider before starting any treatment.

Nutrition

• Vitamin C (1,000 mg two to six times per day in adults for short periods) helps skin heal and can lower histamine levels (which cause hives). Lower dose if diarrhea develops.
• B-complex with extra B12 (1,000 mcg per day) aids in skin health. Vitamin B12 injections have helped reduce the severity of hives, but it isn't clear whether taking B12 orally has the same effect. Vitamin B5 or pantothenic acid (5 - 10 mg per day), helps heal wounds.
• Vitamin E (400 - 800 IU per day) and zinc (30 mg per day) help skin heal. Both are also sometimes applied topically.
• Bromelain (250 mg two to three times per day, taken between meals) reduces inflammation.
• Omega-3 fatty acids, such as those found in fish oil (1 g per day), help maintain skin health and may have anti-inflammatory properties. If you take blood-thinning medication, talk to your doctor before taking omega-3 fatty acids.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Talk to your doctor to find out which treatments are best for your particular skin condition.

Applied topically

Some of the following herbs also can be combined into a poultice or skin wash:

• Aloe ( Aloe vera), as a cream or gel
• Agrimony ( Agrimonia eupatoria or procera), an astringent, applied as a poultice. Boil 1 tsp. dried herb in one cup water for 5 - 10 minutes. Cool and apply to a clean, soft cloth and place on affected area.
• Calendula ( Calendula officinalis), or marigold, as an ointment or a tea applied topically. To make tea from tincture, use 1/2 to 1 tsp. diluted in 1/4 cup water. Test skin first for any allergic reaction.
• Marshmallow ( Althaea officinalis) as a topical ointment to help wounds heal and fight inflammation.
• Tea tree oil ( Melaleuca alternifolia) as oil or cream. Apply two times per day to reduce inflammation.
• Astragalus ( Astragalus membranaceus) as an ointment containing 10% of the herb.
• Burdock ( Arctium lappa ) as a compress. Use 1 tsp. herb in one cup boiling water. Cool and apply to clean, soft cloth. Place on affected area.
• Chamomile ( Matricaria recutita ) as an ointment containing 10% of the herb, or as a tea applied topically, to reduce itching. To make tea, boil 3 g of herb in one cup water. Cool and apply to a clean, soft cloth. Place on affected area.
• Gotu kola ( Centella asiatica ) as a cream containing 1% of the herb, to help heal wounds.
• Echinacea or coneflower ( Echinacea angustifolia or purpurea) as a gel or ointment containing 15% of the juice of the herb.
• Slippery elm bark ( Ulmus rubra or fulva) as a poultice. Mix 1 tsp. dried powder in one cup boiling water. Cool and apply to a clean, soft cloth. Place on affected area.
• Rutin (500 mg two times per day) or quercetin (up to 1,000 mg three times per day) may improve skin health.

To relieve itching and help skin heal, you can combine chamomile with marigold or echinacea.

Under a doctor's supervision, for open sores use powdered slippery elm bark , goldenseal (Hydrastis canadensis), and marshmallow. Add enough skin wash to make a paste. Apply to affected area as needed. Get medical attention if signs of infection develop, such as redness, swelling, heat, or pain.

For further skin relief, add powdered oatmeal (or 1 cup of oatmeal in a sock) to a lukewarm bath. Or, make a skin balm from flaxseed oil (2 tbsp.) plain or with 5 drops of oil of chamomile or marigold .

Taken orally

• Evening primrose oil ( Oenothera biennis , 4 - 6 g per day) may help fight skin inflammation. Do not take evening primrose oil if you take blood-thinning medication.
• Pycnogel ( Pinus pinaster , 200 mg per day), an extract of the bark of a particular type of pine tree, helps promote skin health.
• Polypodium leucotomos extract or anapsos (120 mg per day) is an extract from ferns that may reduce inflammation and protect the skin. It has been used in Europe and South America, although studies are lacking. Do not take this extract if you have high blood pressure or take medication for heart disease.
• Thyme ( Thymus vulgaris , 1 - 2 g per day in divided doses). Do not take thyme if you take blood-thinning medication, and never take oil of thyme, which can be toxic.
• Burdock ( Arctium lappa , 2 - 6 g per day) is an anti-inflammatory and antioxidant. Do not take burdock if you have diabetes, or if you take blood-thinning medication or a diuretic (water pills).
• Dandelion ( Taraxacum officinale , 2 - 8 g per day) is another herb with anti-inflammatory and antioxidant properties. Be sure you do not have an allergy to dandelion, and avoid taking the herb if you have liver or gallbladder disease, diabetes, or kidney disease, or if you take blood-thinning medication.
• Gotu kola ( Centella asiatica , 60 mg two times per day) helps improve skin health. Do not take gotu kola if you have high blood pressure or experience anxiety.
• Cat's claw ( Uncaria tomentosa , 250 mg per day) has anti-inflammatory and antioxidant effects. Do not take cat's claw if you have high blood pressure or take blood-thinning medication.

Homeopathy

Some cutaneous drug reactions are life-threatening and require immediate medical attention. Homeopathic remedies can be used to improve symptoms of itching, burning, and swelling. While few studies have examined the effectiveness of specific homeopathic remedies, professional homeopaths may recommend one or more of the following treatments for cutaneous drug reactions based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Apis mellifica -- for red rashes accompanied by hives, swelling, itching, and stinging sensations. Symptoms are relieved by cold applications. This remedy is most appropriate for individuals who tend to be very tired
• Bryonia -- for fine, dry bumps concentrated on the face. Symptoms worsen with movement. This remedy is most appropriate for individuals who are irritable
• Croton tiglium -- for inflamed, itchy skin that is tender to touch. Rash is often concentrated around the scalp, eyes, or genitals
• Graphites -- for rashes that may be cracking and even oozing liquid. Rashes that improve with graphites are often accompanied by chills and a burning sensation. Symptoms worsen with both warmth and cold, damp weather
• Ledum -- for severely inflamed rashes that worsen at night and improve with cool compresses
• Rhus toxicodendron -- for burning and itching that are relieved by hot applications. This remedy is most appropriate for individuals who are generally restless and irritable
• Sepia -- for a dry, brownish-red rash with tiny raised lesions
• Sulphur -- for red, itchy rashes that worsen at night or when exposed to heat. This remedy is most appropriate for individuals who crave cold drinks and may be inactive and irritable
• Urtica urens -- for itchy, burning rashes that worsen with cold air

Acupuncture

Acupuncture can help reduce itching and inflammation of the skin. Most treatments will focus on “cooling surface heat."

Following Up

It is important to stay in touch with your health care provider until the reaction is completely cleared up. If you have severe reactions, wear medical-alert jewelry stating what drugs you are allergic to.

Special Considerations

If you have any questions about any drug -- whether it is prescribed by your health care provider or purchased over the counter -- ask your pharmacist or health care provider.

Supporting Research

American Academy of Dermatology. Guidelines of care for cutaneous adverse drug reactions. J Am Acad Dermatol. 1996;35:458-461.

Balch JF, Balch PA. Prescription for Nutritional Healing. 2nd ed. Garden City Park, NY: Avery Publishing Group; 1997.

Brinkhaus B, Lindner M, Schuppan D, Hahn EG. Chemical, pharmacological and clinical profile of the east Asian medical plant Centella asiatica. Phytomedicine . 2000;7:427-48.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3 ^rd ed. New York, NY: Penguin Putnam; 1997: 226-227, 319-320.

Dambro MR, ed. Griffith's 5 Minute Clinical Consult. Baltimore, Md: Lippincott, Williams & Wilkins; 1998.

Fauci AS, Braunwald E, Isselbacher KJ, et al,, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.

Glowania HJ, Raulin C, Swoboda M. Effect of chamomile on wound healing--a clinical double-blind study. Z Hautkr . 1987 Sep 1;62(17):1262, 1267-71.

Hormann HP, Korting HC. Evidence for the efficacy and safety of topical herbal drugs in dermatology: part I: anti-inflammatory agents. Phytomedicine. 1994;1:161-71.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 255-265.

Koh KJ, Pearce AL, Marshman G, et al. Tea tree oil reduces histamine-induced skin inflammation. Br J Dermatol 2002;147:1212-7.

Lin CC, Lu JM, Yang JJ, et al. Anti-inflammatory and radical scavenge effects of Arctium lappa. Am J Chin Med . 1996;24(2):127-137.

Mao SP, Cheng KL, Zhou YF. Modulatory effect of Astragalus membranaceus on Th1/Th2 cytokine in patients with herpes simplex keratitis. Zhongguo Zhong Xi Yi Jie He Za Zhi . 2004 Feb;24(2):121-3.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993.

Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin, Calif: Prima Publishing; 1998.

Viehmann P. Results of treatment with an Echinacea-based ointment. Erfahrungsheilkunde . 1978;27(6):353-358.

• Review Date: 9/12/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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