(1)
Departments of Internal Medicine & Psychiatry, Yale University School of Medicine, New Haven, CT, USA
Cutaneous reactions are a common adverse effect of medications. Most are mild but some can be serious and require drug discontinuation.
Pathology
Most drug-induced skin reactions are immune mediated.
Etiology
Almost any medication can cause an allergic skin reaction. Common offenders for serious reactions are antibiotics, anticonvulsants, and anticoagulants.
Psychotropic Medications and Skin Reactions
Many psychotropic medications have the potential to cause a skin allergy. Common types are exanthematous eruptions (diffuse red macules or papules) and urticarial rashes (itchy red plaques). Almost any medication can cause these benign skin reactions but some medication classes are more commonly implicated. For example, phenothiazines are associated with exanthems and tricyclic antidepressants (TCAs) are associated with urticaria [1]. Serious skin reactions associated with anticonvulsants are Stevens–Johnson syndrome (SJS ) and Toxic Epidermal Necrolysis (TEN), different stages of a necrolytic syndrome with high mortality.
Most medication-induced skin rashes are benign and resolve on stopping the medication; common rashes are exanthems and urticaria.
Most skin reactions are dose dependent and resolve when the medication is stopped. Onset is usually within hours to days after exposure but can occur at any time. There may be cross-reactivity between drugs within the same class and this should be a consideration especially with serious reactions.
Most medication-induced skin reactions are dose dependent and reversible upon stopping the medication.
See table for skin reactions commonly associated with particular medication classes.
Psychotropic medications and associated skin lesions [1]
Drug/class | Associated skin reaction | |
|---|---|---|
Carbamazepine , lamotrigine | Erythema multiforme | Well-defined macules or papules with distinct color zones |
Lichenoid reaction | Violaceous flat-topped papules usually on trunk | |
SJS /TEN | Diffuse, spreading rash involving mucous membranes causing eventual sloughing of skin | |
DRESS | Maculopapular spreading rash often with facial edema | |
Phenothiazines (and less commonly other antipsychotics) | Photosensivity/photopigmentation | Skin changes in sun exposed areas |
Exanthematous eruptions | Diffuse maculopapular eruptions, itchy | |
Lithium | Hair loss | Usually from scalp, diffuse |
Acneiform eruptions | Reddish papules, pustules on skin follicles | |
Psoriasis | New onset or exacerbation | |
Valproate | Hair loss | Usually from scalp, diffuse |
Pseudolymphoma | Red or violaceous papules, plaques or nodules, itchy | |
SSRIs, SNRIs | Hyperhidrosis | Increased sweating especially in palms |
Exanthematous eruptions | Diffuse maculopapular eruptions, itchy | |
Urticaria | Raised areas of erythema, itchy | |
TCAs | Angioedema | Skin swelling, usually around eyes and lips
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