Drug Eruptions in Pediatric Patients: A Comprehensive Guide
Antibiotics-Related Eruptions
Amoxicillin-Associated Maculopapular Rash
Cause: Amoxicillin, particularly during concurrent EBV infection
Characteristics: Diffuse, non-pruritic maculopapular eruption appearing 7-10 days after drug initiation
Management: Usually self-limiting; discontinuation may be necessary
Note: Up to 80% of patients with EBV infection develop rash when given amoxicillin
Cephalosporin-Induced Urticaria
Cause: Various cephalosporins (cefaclor, cefdinir, cefixime)
Characteristics: Acute urticaria, angioedema within hours of administration
Management: Immediate discontinuation, antihistamines, possible epinephrine in severe cases
Sulfonamide Fixed Drug Eruption
Cause: Trimethoprim-sulfamethoxazole (TMP-SMX)
Characteristics: Well-demarcated, round/oval patches that recur at same sites
Management: Drug discontinuation, topical corticosteroids
Anticonvulsant-Related Eruptions
Carbamazepine DRESS Syndrome
Cause: Carbamazepine, particularly in patients with HLA-B*15:02
Characteristics: Drug reaction with eosinophilia and systemic symptoms
Management: Immediate discontinuation, systemic corticosteroids
Warning: Can be life-threatening; requires immediate intervention
Lamotrigine Stevens-Johnson Syndrome
Cause: Rapid titration of lamotrigine
Characteristics: Severe mucocutaneous reaction with blistering
Management: Immediate discontinuation, intensive care support
Warning: Medical emergency requiring specialist care
Phenytoin Hypersensitivity Syndrome
Cause: Phenytoin, often within first 8 weeks
Characteristics: Fever, rash, lymphadenopathy, hepatitis
Management: Drug discontinuation, supportive care
NSAIDs-Related Eruptions
Ibuprofen-Induced Acute Urticaria
Cause: COX-1 inhibition by ibuprofen
Characteristics: Acute urticaria, angioedema within hours
Management: Discontinuation, antihistamines
Aspirin-Induced Acute Urticaria/Angioedema
Cause: Aspirin sensitivity
Characteristics: Rapid onset urticaria, possible respiratory symptoms
Management: Avoid all NSAIDs, consider desensitization if needed
Antiviral-Related Eruptions
Acyclovir Photosensitivity
Cause: Acyclovir exposure combined with UV light
Characteristics: Sunburn-like reaction in exposed areas
Management: Sun protection, possible dose adjustment
Oseltamivir-Associated Rash
Cause: Oseltamivir (Tamiflu)
Characteristics: Mild maculopapular rash
Management: Usually self-limiting, antihistamines if needed
Chemotherapeutic Agents
Methotrexate-Induced Photosensitivity
Cause: Low-dose or high-dose methotrexate therapy
Characteristics: Erythematous patches in sun-exposed areas, painful erosions
Management: Strict photoprotection, dose adjustment, folate supplementation
Note: Can be exacerbated by concurrent medications
Doxorubicin-Associated Recall Reaction
Cause: Previous radiation site reaction with doxorubicin administration
Characteristics: Erythema, edema, and desquamation at previous radiation sites
Management: Topical corticosteroids, treatment interruption if severe
Warning: Can occur months after radiation therapy
6-Mercaptopurine Hypersensitivity
Cause: 6-MP used in leukemia treatment
Characteristics: Maculopapular rash, fever, pancytopenia
Management: Temporary discontinuation, possibly desensitization
Vaccine-Related Eruptions
MMR Vaccine Exanthem
Cause: Live attenuated measles component
Characteristics: Mild maculopapular rash 7-10 days post-vaccination
Management: Self-limiting, symptomatic treatment if needed
BCG Vaccine Site Reaction
Cause: Local inflammatory response to BCG
Characteristics: Local ulceration, scarring, rarely lymphadenitis
Management: Usually self-limiting, topical care
Varicella Vaccine Vesicular Eruption
Cause: Attenuated varicella virus
Characteristics: Limited vesicular lesions at injection site
Management: No treatment needed, isolate if extensive
Antifungal-Related Eruptions
Terbinafine-Induced Urticaria
Cause: Oral terbinafine therapy
Characteristics: Acute urticaria, possible taste disturbance
Management: Discontinuation if severe, antihistamines
Amphotericin B Red Man Syndrome
Cause: Rapid IV infusion of amphotericin B
Characteristics: Flushing, urticaria, hypotension
Management: Slower infusion rate, premedication
Warning: Monitor vital signs closely during infusion
Fluconazole Fixed Drug Eruption
Cause: Systemic fluconazole
Characteristics: Well-demarcated hyperpigmented patches
Management: Alternative antifungal, topical steroids
Biological Agent Reactions
Adalimumab Injection Site Reaction
Cause: Local immune response to adalimumab
Characteristics: Erythema, itching, burning at injection site
Management: Ice packs, rotation of injection sites
Infliximab-Induced Psoriasiform Eruption
Cause: TNF-α inhibition paradoxical reaction
Characteristics: New-onset psoriasiform plaques
Management: Topical steroids, possible discontinuation
Note: Can occur despite effectiveness for primary condition
Rituximab-Associated Paraneoplastic Pemphigus
Cause: B-cell depletion-related autoimmune response
Characteristics: Severe mucosal erosions, polymorphous skin lesions
Management: Systemic corticosteroids, possible IVIG
Psychiatric Medication Reactions
Risperidone Photosensitivity
Cause: Antipsychotic-induced photosensitivity
Characteristics: Exaggerated sunburn response
Management: Sun protection, dose adjustment
Lithium-Induced Acne
Cause: Lithium effects on follicular proliferation
Characteristics: Monomorphic pustules on trunk and face
Management: Topical antibiotics, possible dose adjustment
Sertraline Hyperhidrosis-Related Miliaria
Cause: SSRI-induced sweating
Characteristics: Multiple tiny vesicles, especially in skin folds
Management: Cooling measures, antiperspirants
Antihistamine and Decongestant Reactions
Diphenhydramine Fixed Drug Eruption
Cause: First-generation antihistamine sensitivity
Characteristics: Recurrent round plaques at fixed sites
Management: Switch to alternative antihistamine class
Pseudoephedrine-Induced Vasculitis
Cause: Sympathomimetic-induced vascular inflammation
Characteristics: Palpable purpura, possible necrosis
Management: Immediate discontinuation, systemic evaluation
Note: May require rheumatology consultation
Cetirizine Acute Urticaria
Cause: Paradoxical reaction to second-generation antihistamine
Characteristics: Widespread wheals, pruritus
Management: Switch to alternative class
Hormonal Medication Reactions
Growth Hormone Injection Site Lipoatrophy
Cause: Recurrent subcutaneous injections
Characteristics: Local fat loss, skin depression
Management: Rotation of injection sites, technique review
Levothyroxine-Associated Alopecia
Cause: Thyroid hormone excess or rapid dose adjustment
Characteristics: Diffuse scalp hair loss
Management: Dose adjustment, monitoring of thyroid levels
Insulin Lipohypertrophy
Cause: Repeated insulin injections at same site
Characteristics: Soft tissue swelling, altered absorption
Management: Site rotation education, technique modification
Immunosuppressant Reactions
Cyclosporine-Induced Hypertrichosis
Cause: Calcineurin inhibitor effect on hair follicles
Characteristics: Excessive hair growth, particularly on face
Management: Cosmetic management, possible dose adjustment
Warning: May significantly impact quality of life
Tacrolimus-Associated Acne
Cause: Immunosuppression-related follicular changes
Characteristics: Inflammatory papules and pustules
Management: Topical antibiotics, careful dose adjustment
Mycophenolate Mofetil Photosensitivity
Cause: Drug-induced photoreaction
Characteristics: Sunburn-like reaction in exposed areas
Management: Strict photoprotection, dose timing adjustment
Local Anesthetic Reactions
Lidocaine Contact Dermatitis
Cause: Type IV hypersensitivity to amide anesthetics
Characteristics: Delayed erythema, vesicles at application site
Management: Patch testing, alternative anesthetic class
Note: Cross-reactivity within amide group common
Benzocaine-Induced Methemoglobinemia
Cause: Oxidation of hemoglobin by local anesthetic
Characteristics: Cyanosis, chocolate-brown blood
Management: Methylene blue, oxygen therapy
Warning: Medical emergency requiring immediate treatment
EMLA Cream Blanching
Cause: Vasoconstriction from lidocaine/prilocaine
Characteristics: Local pallor, temporary sensory changes
Management: Usually self-limiting, warming if needed
Contrast Media Reactions
Iodinated Contrast Immediate Hypersensitivity
Cause: Non-IgE-mediated mast cell activation
Characteristics: Urticaria, angioedema, bronchospasm
Management: Premedication protocol, low-osmolar agents
Warning: Risk assessment before each administration
Gadolinium-Associated Nephrogenic Systemic Fibrosis
Cause: Gadolinium deposition in renal impairment
Characteristics: Progressive skin thickening, joint contractures
Management: Avoid in severe renal dysfunction
Note: Risk assessment of renal function mandatory
Contrast Material Extravasation Reaction
Cause: Mechanical injury from contrast extravasation
Characteristics: Local swelling, erythema, pain
Management: Cold compresses, elevation, monitoring
Gastrointestinal Medication Reactions
Omeprazole-Induced Subacute Cutaneous Lupus
Cause: PPI-triggered autoimmune response
Characteristics: Photosensitive annular plaques, anti-Ro antibodies
Management: Discontinuation, switch to H2 blockers
Note: May persist for weeks after discontinuation
Metoclopramide Urticarial Vasculitis
Cause: Immune complex-mediated inflammation
Characteristics: Persistent urticarial lesions, purpura
Management: Drug discontinuation, systemic steroids if severe
Sucralfate Contact Dermatitis
Cause: Direct irritant effect
Characteristics: Perioral irritation, erythema
Management: Barrier cream, technique modification
Respiratory Medication Reactions
Montelukast-Associated Acute Generalized Exanthematous Pustulosis
Cause: T-cell mediated neutrophilic inflammation
Characteristics: Widespread sterile pustules, fever
Management: Immediate discontinuation, systemic steroids
Warning: Can be severe, requires hospitalization
Inhaled Corticosteroid Perioral Dermatitis
Cause: Local steroid effect on facial skin
Characteristics: Perioral papules, scaling, burning
Management: Spacer device, mouth rinsing
Albuterol-Related Fine Tremor and Flushing
Cause: β2-adrenergic stimulation
Characteristics: Facial flushing, tremulous hands
Management: Dose optimization, technique review
Cardiovascular Medication Reactions
Amiodarone Photosensitivity/Pigmentation
Cause: Drug-induced photoactivated reaction
Characteristics: Slate-gray pigmentation, severe photosensitivity
Management: Strict photoprotection, possible drug change
Note: Can persist months after discontinuation
ACE Inhibitor Angioedema
Cause: Bradykinin accumulation
Characteristics: Non-pruritic swelling of lips, tongue
Management: Discontinuation, switch to ARB
Warning: Risk of airway compromise
Beta-Blocker-Induced Psoriasiform Eruption
Cause: Altered epidermal proliferation
Characteristics: Plaque psoriasis exacerbation
Management: Alternative antihypertensive, topical therapy
Muscle Relaxant Reactions
Baclofen Withdrawal Erythroderma
Cause: Sudden discontinuation of high-dose baclofen
Characteristics: Generalized erythema, fever, pruritus
Management: Gradual tapering, supportive care
Warning: Can be accompanied by autonomic instability
Cyclobenzaprine-Associated Acute Urticaria
Cause: Histamine release reaction
Characteristics: Widespread wheals, angioedema
Management: Discontinuation, antihistamines
Tizanidine-Induced Xerosis
Cause: α2-adrenergic effects on skin
Characteristics: Dry skin, pruritus
Management: Emollients, dose adjustment
Vitamin and Supplement Reactions
Biotin-Associated Acneiform Eruption
Cause: High-dose biotin supplementation
Characteristics: Monomorphic inflammatory papules
Management: Dose reduction, topical treatment
Vitamin A Hypervitaminosis Dermatitis
Cause: Excessive vitamin A supplementation
Characteristics: Dry, scaly skin, hair loss, pruritus
Management: Discontinuation, monitoring of levels
Note: Can cause systemic toxicity
Iron Supplement Pigmentation
Cause: Local iron deposition
Characteristics: Brown-gray skin discoloration
Management: Route of administration change
Dermatological Medication Reactions
Isotretinoin-Induced Pyogenic Granuloma
Cause: Altered vascular proliferation response
Characteristics: Friable vascular nodules, typically periungual
Management: Dose adjustment, local treatment
Note: May require surgical removal if persistent
Topical Steroid-Induced Periorificial Dermatitis
Cause: Prolonged topical steroid use on face
Characteristics: Papules and pustules around mouth, eyes
Management: Gradual discontinuation, alternative therapy
Benzoyl Peroxide Contact Allergy
Cause: Type IV hypersensitivity reaction
Characteristics: Severe burning, erythema, vesiculation
Management: Immediate discontinuation, patch testing
Ophthalmological Preparation Reactions
Timolol Eye Drop Periocular Dermatitis
Cause: Local irritation from beta-blocker drops
Characteristics: Periorbital eczema, scaling
Management: Application technique modification, barrier cream
Atropine Drop-Induced Facial Flushing
Cause: Anticholinergic systemic absorption
Characteristics: Bright facial erythema, reduced sweating
Management: Nasolacrimal occlusion technique
Warning: Monitor for systemic anticholinergic effects
Fluorescein-Associated Urticaria
Cause: Immediate hypersensitivity to dye
Characteristics: Acute urticaria post-administration
Management: Antihistamine premedication if needed
Dental Medication Reactions
Chlorhexidine-Induced Anaphylaxis
Cause: IgE-mediated hypersensitivity
Characteristics: Systemic reaction, urticaria, hypotension
Management: Emergency treatment, future avoidance
Warning: Life-threatening potential
Eugenol Contact Stomatitis
Cause: Direct mucosal irritation
Characteristics: Oral erosions, burning sensation
Management: Alternative dental material, oral care
Fluoride Gel Chemical Burn
Cause: High concentration fluoride contact
Characteristics: Mucosal whitening, pain
Management: Immediate irrigation, symptomatic care
Alternative Medicine Reactions
St. John's Wort Phototoxicity
Cause: Hypericin-induced photosensitivity
Characteristics: Severe sunburn-like reaction
Management: Discontinuation, photoprotection
Note: Can interact with many medications
Tea Tree Oil Contact Dermatitis
Cause: Essential oil sensitivity
Characteristics: Local eczematous reaction
Management: Dilution protocol, patch testing
Chinese Herb Nephropathy-Associated Skin Changes
Cause: Aristolochic acid toxicity
Characteristics: Xerosis, pigmentation changes
Management: Immediate discontinuation, renal monitoring
Warning: Risk of permanent kidney damage
Sports Supplement Reactions
Creatine-Associated Acne
Cause: Hormonal influence on sebaceous glands
Characteristics: Truncal acne, facial flares
Management: Dose reduction, topical treatment
Pre-Workout Supplement Vasculitis
Cause: Multiple stimulant ingredients
Characteristics: Palpable purpura, livedo reticularis
Management: Discontinuation, vasculitis workup
Warning: May indicate underlying vascular sensitivity
Protein Supplement-Induced Urticaria
Cause: Whey or soy protein allergy
Characteristics: Acute urticaria post-consumption
Management: Allergen identification, alternative protein source
