The following symptoms and complaints may occur together with drug exanthema:
Leading symptom
- Exanthem (rash):
- Primarily macular (blotchy) or maculopapular (blotchy and with papules, i.e., vesicles; = maculopapular exanthema (MPE)) (Type IV allergy) (most common form);
- Other forms are: scarlatiniform (“reminiscent of scarlet fever“), ruebeoliform (“reminiscent of rubella“), morbilliform (“reminiscent of measles“), psorasiform (“reminiscent of psoriasis“).
Localization: V. a. trunk, rarely palms, soles and mucous membranes (spread from trunk to extremities; DD viral exanthema (skin lesions): spread from head to trunk).
Associated symptoms
- Urticaria/hives (occurrence less common than maculopapular exanthema; type I allergy, immediate type).
- Fever and feeling of illness
The typical drug exanthema usually occurs three to seven (2-14) days after the start of ingestion* . The skin lesions may vary in size, color, distribution, depending on the triggering noxious agent. After discontinuation of the drug responsible, drug exanthema may worsen over several days before improvement within one to two weeks.
* The dangerous hypersensitivity syndrome or DRESS syndrome (= drug rash with eosinophilia and systemic symptoms, syndrome), on the other hand, often does not occur until six weeks after the start of medication.
Typical drug rashes and their triggers.
| Drug | Exanthem |
| Ampicillin | morbilliform (“reminiscent of measles”) |
| ACE inhibitors, beta blockers, furosemide | lichenoid (lichen-like) |
|
Antibiotics (ampicillin, tetracyclines, metronidazole), barbiturates, quinine, dimenhydrinate, nonsteroidal anti-inflammatory drugs (NSAIDs), sulfonamides (cotrimoxazole, dapsone).
Note: Foods such as legumes and tomatoes can also be considered triggers; also saccharin or chicken egg white. |
Fixed toxic drug eruption (FTA; recurrence at the same site with repeated ingestion):
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