eMedicine Specialties > Dermatology > Allergy & Immunology

Drug Eruptions: Follow-up

Author: Jonathan E Blume, MD, Instructor in Clinical Dermatology, Columbia University College of Physicians and Surgeons; Consulting Staff, Westwood Dermatology and Dermatologic Surgery Group PA
Coauthor(s): Thomas N Helm, MD, Clinical Associate Professor, Departments of Dermatology and Pathology, State University of New York at Buffalo; Director, Buffalo Medical Group Dermatopathology Laboratory; Michelle Ehrlich, MD, Fellow for the American Academy of Cosmetic Surgery, Staff Physician, Department of Dermatology, La Jolla SpaMD; Charles Camisa, MD, Head of Clinical Dermatology, Vice-Chair, Department of Dermatology, Cleveland Clinic Foundation
Contributor Information and Disclosures

Updated: Jan 5, 2009

Follow-up

Prognosis

  • Full recovery without any complications is expected for most drug eruptions.
  • Even after the responsible agent is discontinued, drug eruptions may clear slowly or worsen over the next few days. The time required for total clearing may be 1-2 weeks or longer.
  • Patients with exanthematous eruptions should be counseled to expect mild desquamation as the rash resolves.
  • Patients with hypersensitivity syndrome are at risk of becoming hypothyroid, usually within the first 4-12 weeks after the reaction.
  • The prognosis for patients with TEN is guarded. Scarring, blindness, and death are possible.

Patient Education

  • If the responsible drug is identified, advise the patient to avoid that drug in the future. Clearly label the medical record. Advise patients to carry a card or some other form of emergency identification in their wallets that lists drug allergies and/or intolerances, especially if they have had a severe reaction.
  • Advise patients about drugs that are cross-reactive and about drugs that must be avoided. For example, penicillin allergy reactions have cross-reactivity with cephalosporins, phenytoin hypersensitivity syndrome has cross-reactivity with phenobarbital and carbamazepine, and sulfonamide reactions cross-react with other sulfa-containing drugs.
  • For excellent patient education resources, visit eMedicine's Allergy Center. Also, see eMedicine's patient education article Drug Allergy.

Miscellaneous

Medicolegal Pitfalls

  • Drug reactions are a common reason for litigation. Not warning a patient about potential adverse effects, prescribing a medicine to a previously sensitized patient, and prescribing a related medication with cross-reactivity are the most common medicolegal pitfalls.
  • Failure to diagnose a reaction to medication may prompt litigation. If anticonvulsant hypersensitivity is not recognized early and the drug is not withdrawn promptly, death or liver failure may result.
  • Early recognition, transfer to a burn unit, and possibly IVIG may decrease the mortality and morbidity of SJS and TEN.
 


More on Drug Eruptions

Overview: Drug Eruptions
Differential Diagnoses & Workup: Drug Eruptions
Treatment & Medication: Drug Eruptions
Follow-up: Drug Eruptions
Multimedia: Drug Eruptions
References
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Further Reading

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Keywords

adverse cutaneous drug reactions, cutaneous reaction to drugs, drug-induced cutaneous reactions, mucocutaneous drug reactions, dermatoses, dermatosis, cutaneous eruptions, cutaneous drug reactions, adverse drug reactions, drug allergy, fixed drug reactions, medication adverse effects, medication side effects, adverse effects, side effects, medication allergy

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Contributor Information and Disclosures

Author

Jonathan E Blume, MD, Instructor in Clinical Dermatology, Columbia University College of Physicians and Surgeons; Consulting Staff, Westwood Dermatology and Dermatologic Surgery Group PA
Jonathan E Blume, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, American Medical Association, American Society for Dermatologic Surgery, International Society of Dermatology, and National Psoriasis Foundation
Disclosure: Nothing to disclose.

Coauthor(s)

Thomas N Helm, MD, Clinical Associate Professor, Departments of Dermatology and Pathology, State University of New York at Buffalo; Director, Buffalo Medical Group Dermatopathology Laboratory
Thomas N Helm, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for Dermatologic Surgery, and American Society of Dermatopathology
Disclosure: Nothing to disclose.

Michelle Ehrlich, MD, Fellow for the American Academy of Cosmetic Surgery, Staff Physician, Department of Dermatology, La Jolla SpaMD
Disclosure: Nothing to disclose.

Charles Camisa, MD, Head of Clinical Dermatology, Vice-Chair, Department of Dermatology, Cleveland Clinic Foundation
Charles Camisa, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Neil Shear, MD, Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Women's College Health Sciences Center and Women's College Hospital, Canada
Neil Shear, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics, Canadian Dermatology Association, Canadian Medical Association, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting; Genetech Honoraria Consulting; Celgene Honoraria Consulting

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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