Exanthematous drug eruptions. • «rashes». • Urticaria immediate reactions. • Delayed appearing exanthems with cell infiltration it is frequent. Therapy for exanthematous drug eruptions is supportive, involving the administration of oral antihistamines, topical steroids, and moisturizing. Morbilliform or exanthematous drug reaction (maculopapular drug eruption). Authoritative facts about the skin from DermNet New Zealand.

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In the dermis, there is a lymphocytic infiltrate with eosinophils.

Morbilliform Drug Eruptions (exanthematous drug eruption; maculopapular drug eruption, “drug rash”)

Morbilliform drug eruption [exanthematous drug eruption; maculopapular drug eruption, “drug rash” Are You Confident of the Diagnosis? You must be a registered member erjption Dermatology Advisor to post a comment.

The starting date of each new drug is documented together with the onset of the rash. Mid- or high potency topical steroids such as triamcinolone acetonide 0.

Clinical practice. Exanthematous drug eruptions.

The rash may be associated with a mild fever and itch. The patient should be made aware that pruritus and erythema may be severe. Toxin-mediated erythemas, such as toxic shock syndrome and Strep toxic shock-like syndrome may present with an eruption that resembles MDE.

Confluence and severity is worst in dependent areas, eruphion as the back druf hospitalized patients Figure 1. On re-exposure to the causative or related drug, skin lesions appear within 1—3 days. In cases where the offending drug is not able to be discontinued, a discussion should be held regarding the risks and benefits of this, both with the dermatologist and the primary subspecialty team concerned.


On the first occasion, a morbilliform rash usually appears 1—2 weeks after starting the drug, but it may occur up to 1 week after stopping it. Antibiotics dug commonly beta-lactams, sulphonamides, quinolonesanticonvulsants phenytion, cabamazepine, lamotriginenon-steroidal anti-inflammatory drugs NSAIDs and allopurinol are common culprits.

Med Clin North Am. A sandpaper-like eruption accompanies a sore throat and fever. Diagnosis confirmation The following conditions should be considered in the differential diagnosis: The history of upper respiratory tract symptoms and the presence of a lymphocytosis or lymhopenia on the white blood cell differential count as opposed to an eosinophilia point one towards a viral etiology. Lipodystrophy syndrome, nucleoside reverse transcriptase inhibitors, and protease inhibitors”.

MDE is usually itchy. Further investigations will depend on clinical features, progress of the adalwh, and the results of the initial tests.

Morbilliform Drug Eruptions (exanthematous drug eruption; maculopapular drug eruption, “drug rash”)

See the DermNet NZ bookstore. There is a higher risk of all drug eruptions in the HIV-positive population and in women. Morbilliform drug eruption [exanthematous drug eruption; maculopapular drug eruption, “drug rash”.

Powered By Decision Support in Medicine. To identify the possible causative drug, a drug calendar, including all prescribed and over-the counter products, may be helpful. A strong clinical suspicion of morbilliform drug eruption depends on:. The distribution is bilateral and symmetrical. The diagnosis is made based on the typical clinical appearance in concert with an appropriate drug history and the absence of systemic involvement.

Antibiotics against group A Streptococcus should be administered. The face may be involved, but mucous membranes are typically spared. A targetoid appearance to plaques and macules may be noted at this stage.


Morbilliform drug eruption is also called maculopapular drug eruptionexanthematous drug eruption and maculopapular exanthem. Antiretroviral agents, such as the protease inhibitors, emtricitabine and tenofovir, and tealprevir for hepatitis C infection have also been reported to induce MDE.

Morbilliform drug eruption usually first appears on the trunk and then spreads to the limbs and neck. Self-skin examination New smartphone apps to check your skin Learn more Sponsored content. DermNet NZ does not provide an online consultation service.

Here Th 2 cells secrete interleukins 4, 13 and 5, which call eosinophils into the infiltrate, amongst other functions. On rechallenge with a drug that the patient has been sensitized to in the past, the eruption may occur within 24 hours.

The eruption usually begins on the trunk and upper extremities and progresses caudally. Exanthem Drug eruptions Allergies explained Other websites: Type IV hypersensitivity has been subdivided into four groups, depending on whether monocytes type IVaeosinophils type IVbor neutrophils type IVd are predominantly activated or whether there is T-cell-mediated apoptosis type IVc.

An uncommon finding is the development of erythroderma in patients in whom the offending drug is not stopped.

In typical cases, a biopsy is not required. Morbilliform drug eruption is a form of allergic reaction. Etiology A multitude of drugs have been implicated in MDE. Differential diagnosis includes measlesrubellascarlet fevernon-specific toxic erythema associated with infectionKawasaki diseaseconnective tissue disease and acute graft-versus-host disease.