Other Drug Eruptions

Fixed drug eruption is a localized drug reaction that occurs in the same spot every time a patient is exposed to the responsible medication. It presents as a painful red plaque, that can blister and often leaves behind darkened skin. With subsequent re-exposures to the medication, more sites may become involved. In addition to antibiotics such as tetracyclines and trimethoprim-sulfamethoxazole, common causes include NSAIDs and acetaminophen.

Drug-induced acne. Any topical ointment may lead to worsening acne by  clogging pores. Inappropriate use of topical corticosteroids may also cause acne or rosacea on the face. Retinoinds can lead to a flare of acne when they are first started, so patients should be counselled that things might get “worse before they get better”. Systemic corticosteroids, lithium, phenytoin and iodides (found in contrast media) are common causes of drug-induced acne in addition to those listed below. Anabolic steroids may also worsen acne. Drug-induced acne often presents with acute flare and monomorphous (all similar to each other) skin lesions. Sometimes systemic steroids lead to Malassezia folliculitis that resembles acne, but has no associated comedones. Psoriasis may also be triggered or worsened by certain medications including lithium, beta-blockers and antimalarials (e.g. hydroxychloroquine). Though TNF inhibitors are often used to treat psoriasis, in some cases, they may paradoxically cause it to flare when used to treat other conditions, such as inflammatory bowel disease.