Drug Rash: Which Drugs Cause Skin Symptoms?

Drug rash refers to skin reactions as a side effect of certain medications. These rashes can vary from mild to severe and may appear as red spots, hives, or peeling skin. Common drugs that cause such reactions include antibiotics like penicillin, anticonvulsants such as phenytoin, and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.1

Understanding which medications are linked to skin symptoms is crucial for managing and treating drug-induced rashes effectively.

Drugs With Rash as a Side Effect

Rashes are one of the most common side effects of many medications. Symptoms can occur immediately or sometimes be delayed several hours, days, or even weeks, as follows:2

• Hives: These are raised, very itchy spots that can appear and disappear within a few hours and change in size and location.
• Rashes: These red, blotchy, or scaly patches may be itchy can spread slowly over a few days and do not change rapidly. They may first appear soon after starting the medication and are not likely to be a sign of a serious allergy.
• Stevens-Johnson syndrome (SJS): SJS is a rare but potentially life-threatening condition that causes painful skin blisters and can lead to skin detachment and other serious complications.
• Toxic epidermal necrolysis: This is a very rare and more severe form of SJS.3

Even though medications have side effects like rashes, not everyone will get them. Some of the medications that can cause a rash as a side effect include:

Penicillin

Penicillin and other beta-lactam antibiotics are well-known for causing allergic reactions, including rashes. When people have allergy symptoms like a rash with any of the medications in the penicillin family, they should avoid the entire drug group. These include medications such as amoxicillin, dicloxacillin, flucloxacillin, and any other medication with "cillin" at the end.4

While taking penicillin, the more common types of skin reactions are hives, or flat, blotchy rashes.4

Cephalosporins

Cephalosporins, another class of antibiotics, can also cause rashes that may present as red spots or hives. These reactions are similar to those caused by penicillin and may indicate a serious allergy.5

Sulfonamides

Sulfonamides, commonly known as sulfa drugs, are a group of antibiotics used to treat various bacterial infections. Sulfonamide allergies can cause several types of skin rashes that range from mild to severe, including hives, rashes, and Stevens-Johnson syndrome.6

Rashes can appear within 30 minutes to one to two weeks after starting sulfonamide treatment. The onset can vary depending on the individual's immune system's response to the drug.7

Phenytoin

Phenytoin (brand name Epanutin), an anticonvulsant used to manage seizures, is associated with rashes that may range from mild to severe. Fortunately, most phenytoin skin rashes are not serious.8

Most phenytoin skin rashes start in the first eight weeks of treatment or when the dose is increased too quickly. Phenytoin can also cause the rare side effect of Stevens-Johnson syndrome.8

Carbamazepine

Carbamazepine (brand name Curatil) another anticonvulsant, is also linked to various skin rashes, including those that might signal more serious conditions like Stevens-Johnson syndrome or toxic epidermal necrolysis.910 Although uncommon, these can be life-threatening and cause the skin to blister and peel.11

Ibuprofen

Advil and Motrin (ibuprofen) are common NSAIDs that can cause skin reactions, particularly in individuals sensitive to it. Other NSAIDs in this category include aspirin (acetylsalicylic acid) and Aleve (naproxen).12 While usually mild, these rashes can sometimes develop into more serious conditions.

Skin side effects may include:13

• General skin rashes, which can appear in various forms
• Hives and swelling
• Itching
• A rash that resembles measles, consisting of both red spots and raised bumps called a morbilliform rash
  

Allopurinol

Allopurinol is treats gout, but it can cause rashes that vary in severity. Common early side effects are skin rashes and mild itching. Much less commonly, severe skin conditions such as exfoliative dermatitis (erythroderma) or Stevens-Johnson syndrome can develop.14

Erythroderma is a widespread redness of the skin, or purple-tinged coloration in darker skin. It is accompanied by scaling, itching, peeling, and flaking of the skin and may include hair loss.1516

Methotrexate

Methotrexate, a medication used to treat cancer and autoimmune diseases, can cause skin rashes that range from mild redness to severe peeling and blistering. These rashes are often a sign of drug toxicity. If you are taking methotrexate and develop a rash, call your healthcare provider right away.17

Opioids

Opioids, such as morphine, oxycodone, and fentanyl, can cause skin reactions ranging from mild rashes to more severe symptoms like itching or hives. These rashes are often related to allergic reactions or sensitivities to the medication.

All opioids can trigger allergic reactions such as rashes. Most of these reactions are pseudo allergies, which occur because opioids cause the body to release histamine, leading to symptoms like itching, hives, and sweating. A true allergy to opioids is rare and involves more severe symptoms, such as severe skin rashes or trouble breathing.18

How Drug Rash Symptoms Look

If you or a loved one is taking a medication and notice a skin rash, contact your healthcare provider for instructions. Here are some things to look for:

Color

Rashes can appear in localized areas or be more generalized, covering large portions of the body. Red and pink areas may be more challenging to see in people with darker skin colors.19

Shape and Texture

The shape and texture of drug rash symptoms depend on the kind of rash and may include:20

• Flat: Smooth, even patches of color
• Raised: Bumps or hives that may be itchy
• Blotchy: Irregular, uneven patches
• Scaly: Dry, flaky areas of skin

Sensations

Common rash sensations may vary and include:2122

• Itching of the skin or eyes
• Burning sensations
• Pain or discomfort in the rash area
• Raised, swollen areas
  

Timing of Drug Rash

The timing of drug rashes varies widely depending on the type of reaction and the specific medication involved. Symptoms of a drug allergy typically appear within one hour of taking the medication. However, reactions can sometimes be delayed, occurring several hours, days, or even weeks later.23

Symptoms of immediate drug rash reactions within one hour may include:23

• Red and warm skin
• Blotchy rash
• Hives
• Itching
• Swollen mucous membranes
• Fluid retention in skin tissues

Symptoms of delayed reactions within a few days to two weeks:23

• Skin rash
• Fever
• Organ damage, large areas of skin peeling off, or significant facial swelling, all rare

Understanding these symptoms' timing is crucial for effectively identifying and managing drug allergies. Immediate reactions are usually easier to diagnose due to their quick onset, whereas delayed reactions may require more detailed patient history and investigation to pinpoint the cause.

Treating a Drug Rash at Home

Treating a drug rash at home involves several steps to manage symptoms and prevent further irritation. If you suspect a rash is due to medication, contact your healthcare provider. They may recommend your stopping the drug and prescribe another medicaiton.21

Over-the-counter (OTC) remedies for drug rash include:21

• Antihistamines: Oral antihistamines, such as Benadryl (Diphenhydramine) can help relieve itching.
• Topical steroids: Hydrocortisone cream can reduce redness and swelling.

When to Follow Up With a Provider

If you are taking a medication and think you are having a reaction, contact your healthcare provider for further guidance.21

For emergency conditions like difficulty breathing or severe symptoms of asthma or anaphylaxis, go to the emergency room or call 911 immediately.

Summary

Drug rashes are a common side effect of various medications, including antibiotics, anticonvulsants, and NSAIDs. These skin reactions can range from mild hives to severe conditions like Stevens-Johnson syndrome. It's crucial to identify the medications causing these reactions for effective management and treatment. Always contact your healthcare provider if you suspect a drug rash, and seek immediate medical attention for severe symptoms.