[Cutaneous drug reactions]

Adverse cutaneous reactions to drugs are frequent in general practice. This article is a review of current knowledge of the pathogenesis, differential diagnosis and practical management of this wide spectrum of cutaneous manifestations.

Recent studies, guidelines and textbooks are reviewed. The literature was identified on PubMed and supplemented by clinical experience from two university hospitals in Oslo, Norway.

Adverse cutaneous reactions to drugs are frequent, though most reactions are mild and self-limiting. Drug reactions in the skin may be difficult to distinguish from viral exanthemas and other skin diseases. Serious reactions are potentially life-threatening and in need of treatment in intensive-care units. Of the 1350 drugs registered in Norway, the most frequent drugs involved in serious drug reactions are antibiotics, non-steroidal anti-inflammatory drugs, and anticonvulsants. Cutaneous drug reactions can be markers of underlying disease, such as HIV infection or lymphoproliferative diseases. Withdrawal of the suspected drug is essential for prognosis. It is also important to perform a causality assessment of the suspected drug reaction so that it can be avoided in the future, as well as to put emphasis on patient education.