Drug Eruptions – Types, Symptoms, Treatment

What is a drug eruption?

Drug eruption is adverse drug reaction of the skin. Any kind of acute or sub-acute adverse cutaneous reactions to a drug or medicine include drug eruptions.

Drug eruption may range from unnoticed mild rash to severe cutaneous adverse reaction (SCAR) that may be life-threatening.

Types of drug eruption

There are many types of drug eruption . The most common drug eruptions include 

• Morbilliform or exanthematous drug eruption
• Urticaria and/or angioedema (which rarely leads to anaphylaxis).

SCARs are rare:

• Drug hypersensitivity syndrome
• Stevens–Johnson syndrome / toxic epidermal necrolysis (SJS/TEN).

Many other cutaneous adverse reactions include :

• Acute generalised exanthematous pustulosis (AGEP) (pustular psoriasis-like)
• Serum sickness (urticaria, fever, arthralgia, lymphadenopathy)
• Hypersensitivity vasculitis (palpable purpura)
• Fixed drug eruption 
• Lichenoid drug eruption  in which lichen planus-like reaction is seen.
• Drug-induced sensitivity: Sunburn or eczema in sun exposed sites due to phototoxicity or photoallergy 
• Bullous drug eruptions 
• Lupus erythematosus that is induced by drug

Sometimes cutaneous drug eruption is another name used for drug eruption. Drug eruption  sometimes affects  hairs and nails also.

Some drugs can also cause drug eruption :

• Skin pigmentation induced by drug
• Skin problems which are not commonly caused by a drug For eg. Eczema triggered by retinoids ,  psoriasis triggered by lithium etc.
• Systemic contact dermatitis
• Allergic contact dermatitis and photocontact dermatitis
• Hair loss or increase in hair (hypertrichosis)
• Nail dystrophy , changes or pigmentation.

Some drugs that are commonly responsible for causing reactions, include

• Hormones such as antiandrogens
• Chemotherapy drugs
• Anticoagulants
• Topical and systemic corticosteroids
• Calcineurin inhibitors
• Epidermal growth factor inhibitors and targeted cancer therapies.

Who gets drug eruptions?

• On average, new medications prescribed leads to a drug eruption in some people.
• Allergic reactions to some drugs are more commonly seen in females than in males.
• Genetic factors also play a role in causing drug eruptions. 
• Various kinds of viral infections and diseases can influence reactions.
• Any kind of allergic drug reaction that occur previously  or drug intolerance increases the risk of reaction to another drug. 
• Cross-reactions can occur due to sensitivity to certain sunscreens, cosmetics, foods or insect bites.

Causative factors for drug eruptions

There are several factors that cause drug eruptions which are

• True allergy: occur due to immunological mechanism
• Immediate reactions occur within an hour of drug exposure and are mediated by IgE antibodies (urticaria, anaphylaxis).
• Delayed reactions occur after 6 hours or after several weeks of exposure to drug . They may be due to  IgG antibody, immune complex, or cytotoxic T cells.
• Drug intolerance (i.e, dose-related reactions)
• Pseudo allergy i.e. a reaction that is assumed to be an allergy but is actually occur due to release of mast cell mediators by the drug [opioids, NSAIDs].

What are the clinical features of drug eruptions?

Other symptoms that are seen in Drug eruption other than the allergic reaction are

• Fever
• Malaise
• Involvement of other organs like in SCAR

Diagnosis of drug eruptions

• Diagnosis of drug eruptions can be made by taking careful history and by doing general physical examination of patient.
• Some investigations like blood test, liver function and kidney function test are helpful
• Skin intradermal/prick tests are helpful to check immediate reactions to penicillin and few other drugs. 
• Sometimes it become difficult to determine responsible drug for rash . As very few drug reactions have a confirmatory test.

Treatment options for drug eruptions

• Most appropriate way to treat the condition is to detect and stop the responsible medication.
• If rash or allergic reaction is severe   then use of systemic steroids for drug eruptions can be done. Topical use of corticosteroids is helpful and helps to reduce the symptoms.
• Drug-induced urtic area can be treated with antihistamines.  

Prevention of drug eruptions

• Drug eruptions are commonly due to antibiotics, so avoid use of antibiotics or use should be limited.
• A medical record of drug allergies of patients should be maintained.  Patients should remain alert and should remind of their previous allergic reaction that occurred in past.

Chandigarh Ayurved centre provides effective Ayurvedic  treatment for drug eruptions . CAC provides a kit named ‘Allergy care kit’. This kit contains medications that are very effective to treat any kind of allergic reaction. 

Description of medicines

1. Detox Premium Powder

The powder is very beneficial to cure any kind of body pain as it removes excess toxins from the body and balances the aggravated pitta and vata dosha. It consists of several herbs and bhasmas such as shukta pishti, giloy satv, parwal pishti, kamdudha rasa, moti pishti, gandhak rasayan, akik pishti, etc. The ingredients help in reducing swelling, redness, shrinkage of tear lining in the anus, burning sensation, etc.

2. Nerve up tablet

Nerve up tablets help in balancing the vata doshas. It reduces kapha dosha, and acts as nervine stimulant. It shows effective results in improving the central nervous system. It contains natural ingredients like shudha kuchala, shudha shilajeet, abhrak bhasma, praval pishti, shankh bhasma etc. This tablet helps in the symptoms related to Allergy.

3. Curcumin Capsule

Curcumin Capsule helps in pacifying all three doshas. Curcumin Capsule is beneficial for variety of skin conditions like Acne, Eczema, Psoriasis, and Dermatitis. This Capsule contains standardized extract of the herb Curcumin (Curcuma longa). Curcumin is the active ingredient in Turmeric having powerful Anti-inflammatory, Antibacterial, Antifungal, Anti-microbial and Antioxidant properties.

4. Amrit Tulsi Ras

This herbal preparation is in drops form prepared from five types of Tulsi. Shama Tulsi (Ocimum sanctum), Rama Tulsi (Ocimum gratissimum), Kapoor Tulsi (Ocimum canum), Shwet Tulsi (Ocimum basilicum), Nimba Tulsi (Ocimum citriodorum) that provides good result in all allergic reactions.

5. Immuno Booster Tablet

It is a pure herbal combination that helps to build up immunity. It consists of effective levels of antioxidants. vitamin C and E circulate in the body to protect it against the damage caused by free radicals. It has natural immunity-boosting properties to prevent and ease cough, cold, headache, and infections. it provides quick relief from early signs of running nose, itching throat, body ache, and weakness.