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Cutaneous Reactions Clnical Features Implicated Medications
Exanthems Diffuse fine macules and papules
Evolve over days after drug initiation
Delayed-type hypersensitivity
Allopurinol, aminopenicillins, cephalosporins, antiepileptic agents, and antibacterial sulfonamides
Urticaria, angioedema Onset within minutes of drug initiation
Potential for anaphylaxis
Often IgE mediated
IgE mediated: β-lactam antibiotics
Bradykinin mediated: ACE-Is
Fixed drug eruption Hyperpigmented plaques
Recur at same skin or mucosal site
Tetracyline, NSAIDs, and carbamezapine
Pustules Aceneiform
Acute generalized eczematous pustulosis (AGEP)
Acneiform: corticosteroids, sirolimus
AGEP: antibiotics, calcium-channel blockers
Bullous Tense blisters
Flaccid blisters
Furosemide, vancomycin
Captopril, penicillamine
SJS Fever, erosive stomatitis, ocular involvement, purpuric macules on face and trunk with <10% epidermal detachment Antibacterial sulfonamides, anticonvulsants, oxicam NSAIDs, and allopurinol
TEN Similar features as SJS but >30% epidermal detachment
Mortality as high as 50%
Same as SJS
Cutaneous lupus Erythematous/scaly plaques in photodistribution Hydrochlorothiazide, calcium-channel blockers, ACE-Is


Extracutaneous Reactions Clnical Features Implicated Medications
Hematologic Hemolytic anemia, thrombocytopenia, granulocytopenia Penicillin, quinine, sulfonamides
Hepatic Hepatitis, cholestatic jaundice Para-aminosalacylic acid, sulfonamides, phenothiazines
Pulmonary Pneumonitis, fibrosis Nitrofurantoin, bleomycin, methotrexate
Renal Interstitial nephritis, membranous glomerulonephritis Penicillin, sulfonamides, gold, penicillamine, allopurinol


Multiorgan Reactions Clnical Features Implicated Medications
Anaphylaxis Urticaria/angioedema, bronchospasm, gastrointestinal β-lactam antibiotics, mAbs symptoms, hypotension
IgE- and non–IgE-dependent reactions
β-lactam antibiotics, mAbs
DRESS Cutaneous eruption, fever, eosinophilia, hepatic dysfunction, lymphadenopathy Anticonvulsants, sulfonamides, minocycline, allopurinol
Serum Sickness Arthralgias, myalgias, fever, malaise Hydralazine, procainamide, isoniazid
Vasculitis Cutaneous or visceral vasculitis Hydralazine, penicillamine, propylthiouracil