Cutaneous Drug Eruptions in Pediatrics—A Primer

Abstract

Cutaneous adverse drug reactions (ADRs) are commonly seen in the pediatric population in both inpatient and outpatient settings and are important to identify, evaluate, and appropriately manage. Early recognition and proper classification of a cutaneous drug reaction allows the clinician the ability to narrow in on a culprit drug and determine whether the medication is safe to continue. This review discusses the clinical presentation, categorization, and management of cutaneous ADRs in the pediatric population. [ Pediatr Ann . 2020;49(3):e132–e139.]

Cutaneous sıde‐effects of the potential COVID‐19 drugs

“…In the management of the cutaneous anti‐COVID 19 drug eruptions, medium‐to‐high potency topical corticosteroids generally sufficed, although oral antihistamines and corticosteroids were occasionally needed. In severe cases, we can start at cyclosporin 5 mg/kg/day and IVIG treatments 48 . Early diagnosis of a cutaneous drug eruption allows the clinician the ability to narrow in on a culprit drug and determine whether the medication is safe to continue.…”

“…Complete blood count analysis with atypical lymphocytosis, neutrophilia, eosinophilia, higher blood drug, histamine, tryptase and beta‐tryptase levels, cutaneous histopathologic examinations with the presence of eosinophils, edema, and inflammation may indicate cutaneous drug eruptions. A good and complete history taking is very vital and helpful for the differential diagnosis 48 . We should obtain the history anti‐COVID‐19 and other drug exposures including dosage, date started, duration and interruptions in use, initiation of drug use and the onset of reaction, previous adverse cutaneous drug reactions, and type of adverse reaction and previous family or personal history of skin drug eruptions, hypersensitivity syndromes and atopy.…”

Drugs and the skin: A concise review of cutaneous adverse drug reactions

“…This is one of the most common presentations of CADRs, and it is characterized by a diffuse, small, pink to red macules and papules that coalesce into patches and plaques that initially affect the trunk and then rapidly spread to proximal and sometimes distal extremities with a symmetrical distribution. 8 Drugs often associated with morbilliform reactions include antibiotics (most common), antiepileptic and NSAIDs. Drug-induced morbilliform skin rash usually presents within the first weeks of exposure (4-21 d) to a new drug.…”

“…In some patients, however, cutaneous manifestations developed months or even years after using the same medication without any previous complications. 10,55 The term morbilliform skin rash was initially used to describe the cutaneous manifestations of the measles infection and now is widely used to describe skin eruptions with similar morphology 8 Morbilliform drug reactions do not present with blistering or sloughing of the skin, and enanthem seldom occurs. 56,57 Other accompanying features include low-grade fever and itchiness of variable intensity, although skin rash is reported to be more tender or painful.…”

“…70 Urticaria is caused by the release of inflammatory mediators form mast cells and basophils either by immune mechanisms such as type I hypersensitivity reaction (e.g., IgE-mediated) and nonimmune mechanisms (direct mastocyte degranulation by NSAIDs). 8 Hives or urticarial lesions could be initially solitary or multiple; their size varies from a few millimetres to several centimetres. Morphology may also vary as small pink papules, macules or large red oedematous wheals.…”