It often happens in babies and children that a drug rash appears on the body after taking a medicine. This is not necessarily something alarming. It could be drug exanthema in the baby and child. Nevertheless, the pediatrician should take an expert look.
What is drug exanthema?
Drug exanthema is one of the drug allergies. The immune system reacts to one or more active ingredients in a drug after the drug is given. In drug exanthema, a red inflammatory, vesicular, or wheal-like rash appears on some areas of the body and may also extend to the entire body. In addition to drug rash, other allergic reactions are also possible, such as diarrhea, vomiting, swelling of the mucous membranes in the mouth and throat, and sometimes fever, especially in babies and young children. The reaction does not even have to be related to the active ingredient itself. Since a drug contains many ingredients, such as fillers, colorings, flavorings, stabilizers, preservatives, etc., drug exanthema can also be a reaction to one of these substances. One of the best known drug allergies is penicillin allergy. For more info, see: Penicillin.
Causes
Drug exanthema always occurs as an allergic reaction of the immune system to one or more components of medications. The inflammatory rash may appear shortly after the medication is given, but it may also occur a few days later. Drug rash is more common with topically applied medications. Medications that frequently cause drug rash include antibiotics, antifungals, antirheumatic drugs, and cardiovascular drugs. Locally, local anesthetics may trigger drug exanthema, among others.
Symptoms, complaints, and signs
Drug exanthema in babies and children is usually noticeable because of redness and swelling. These often occur on the face, but can occur on any part of the body. The redness and swelling vary in size and texture. Drug exanthema can be small and punctate, but it can also cause extensive, raised swellings. Such an exanthema does not necessarily cause discomfort. Depending on the affected part of the body, the exanthema is then also discovered rather accidentally. However, many medicinal exanthem in babies and children cause itching. Scratching the affected body parts usually intensifies these complaints. Itching is annoying and can torment babies and children in particular to such an extent that medication is necessary. In addition to itching, however, drug-induced exanthema can also trigger such swelling that severe indisposition or even respiratory distress occurs. Accordingly, in the case of such signs and external symptoms of a rash, it must be clarified promptly by a physician whether it is an exanthema that does not require treatment or possibly a severe allergic reaction to a drug. Swelling can be severe enough to cause severe shortness of breath or even choking, which must be broken immediately with appropriate medication.
Diagnosis and course
If drug rash is suspected in children, the physician will first stop the medication to find out if the drug rash was caused by that medication. If the rash disappears afterwards, the diagnosis of drug exanthema is certain. It becomes more difficult when several drugs are prescribed and administered at the same time, which is rather not the case with babies and children, so that drug exanthema can be diagnosed relatively quickly here. Drug exanthema usually occurs quite quickly after the prescription of a drug, especially in babies and children. If an inflammatory drug rash forms on some parts of the body or on the whole body immediately or within a few days after ingestion or local administration, it is reasonable to suspect that drug rash is present. After discontinuation of the drug, the drug exanthema usually resolves within a few days. If it is a more severe allergy, it may also take a few weeks for the drug exanthema to disappear.If you as a mother or father are not quite sure and the pediatrician cannot make a clear diagnosis, you should visit a dermatologist with the child and take any remedies or medications that are administered. A prick test, as used for other allergies, is of limited use for drug exanthema because it cannot be used to detect all drug allergies, mainly only antibiotics, anti-inflammatories and cortisone. For a baby and young child, it would be an agonizing procedure to avoid anyway.
Complications
As a rule, drug-induced exanthema in babies and children is not a particularly alarming complaint and does not require treatment in every case. However, parents should always have the symptoms examined by a doctor to prevent possible secondary damage. The child suffers from severe redness of the skin and a rash. This can also be itchy. Parents should prohibit scratching in any case. It is not uncommon for babies and children to experience diarrhea, vomiting and a general feeling of illness as a result of the drug-induced exanthema. The throat and mouth may also become swollen, making it difficult to eat. Usually, no further symptoms or complications occur after the medication is stopped. The symptoms then disappear on their own after a few days. However, a doctor should always be consulted before discontinuing medication or exchanging it for another. If the rash itches and bothers the child a lot, antihistamines can be administered to relieve the symptoms. This also does not cause any further discomfort. The child’s development is not affected by the disease.
When should you go to the doctor?
Drug exanthema in babies and children are not rare reactions to a particular drug. In particular, they are described when antibiotics are taken. Provided that the exanthema is rather localized and painless and the child is otherwise symptom-free, exanthema is not necessarily a reason to see a doctor. The situation is different in the case of a very pronounced exanthema. This should be clarified by a pediatrician. Exanthema over a large area can also be a symptom of another disease, such as measles, rubella or chickenpox. Since these diseases can be serious without treatment and questions about the risk of infection must also be clarified, pediatrician advice is useful. A strong exanthema, which occurs very suddenly, can also mark the beginning of a severe allergic reaction. This is also known as anaphylaxis. This can start with a skin rash and spread to the entire organism up to circulatory failure. Such allergic reactions can also occur with drugs. A severe exanthema coupled with symptoms such as itching, reddening of the skin or conspicuous pallor, coughing, signs of shortness of breath, can therefore be a medical emergency. In this case, a doctor should be consulted immediately or, in very severe forms, an ambulance should be called.
Treatment and therapy
The measure of choice for drug-induced exanthema is always discontinuation of the allergy-causing drug if it can be narrowed down as the trigger. After discontinuation of the drug, the drug exanthema usually resolves fairly quickly. If several drugs are given at the same time and the allergy-causing drug cannot be determined, the pediatrician or dermatologist has the option of treating the drug exanthema with glucocorticoids or – if the rash causes excruciating itching – with antihistamines. Only in very severe allergic reactions is intensive medical observation and treatment indicated.
Outlook and prognosis
Drug-induced exanthema in babies and children has a good prognosis. The symptoms are not considered diseases in their own right but represent a reaction of the organism to medications taken. As soon as the medicine is discontinued, the skin changes in the baby and child disappear. Within a few days, complaints are completely healed. The child is then considered free of symptoms and cured. The affected areas of the skin can be treated with ointments or creams. These help the organism to regenerate the skin as quickly as possible and prevent scarring. If complications occur, the healing process is prolonged.However, they do not normally change the very good prognosis of drug exanthema. The skin changes can lead to itching and as soon as this is indulged in, there is a risk of open wounds. If the wound care is not sterile, germs and pathogens can enter the organism via the open body sites. There is a possibility that further illnesses will develop which will have to be treated. Although the prognosis of drug exanthema in babies and children is markedly positive, the administration of another drug may also cause the body to react. Therefore, recurrence of drug exanthema cannot be ruled out. The prognosis in case of recurrence of symptoms is also very good.
Prevention
Drug exanthema cannot be prevented because any person could basically react to any possible ingredient of a drug. If there is a family history of drug rash, such as to penicillin, it is advisable to inform the pediatrician. If a drug allergy is proven, it will be recorded in the medical record and in an allergy passport.
Follow-up
To be on the safe side, a drug rash in a baby or child should always be presented to the physician who prescribed the triggering drug. In itself, no consequences are expected from drug exanthema in a baby or child. However, the triggering drug should be changed if necessary. It is an allergic reaction to one of the active ingredients or the excipients contained. In such reactions, other allergic manifestations may develop in addition to the exanthema. These can sometimes have a very threatening effect. Therefore, in the follow-up of the acute incident, it is necessary to find out what was the trigger for the drug exanthema in the baby and child. This substance should subsequently be avoided. In most cases, however, it is difficult to determine which ingredient caused these consequences in the first place. Infants should not necessarily be subjected to a prick test. Itching, redness, and swelling can potentially occur from any of the ingredients in a drug. Drug exanthema in babies and children therefore requires prolonged observation of the child. Parents are encouraged to observe other unusual reactions to certain substances to narrow the pool of potential causative agents. Depending on how pronounced and severe the first drug-induced exanthema has turned out to be in the baby or child, the attending physician may suggest further measures.
What you can do yourself
A drug exanthema in babies and children is causally based on a drug allergy, nevertheless this rash is usually harmless in nature. If the exanthema is localized and the child is symptom-free, the drug can continue to be given under strict observation of the corresponding skin area. However, if a drug exanthema spreads rapidly and is also very itchy, this is always an indication of a serious allergic reaction. In this case, the drug is discontinued immediately and the affected skin areas are covered with cooling saline compresses or antipruritic lotions. The attending physician must be consulted within the next one to two hours. If this is not available, the emergency room of the nearest clinic is the right address. If the rash starts only a short time after taking a medication and is accompanied by fever, diarrhea and vomiting or even swelling of the mucous membranes in the mouth and throat, there may be an acute danger to life. Only the emergency physician who has been summoned can decide on further therapy. This ranges from treatment with antihistamines and cortisone to intensive medical care. Parents are best advised to follow these guidelines: The younger the child and the more directly the drug exanthema is related to a drug administration, the more quickly immediate medical help is indicated.
