Drug-induced Skin Disorders

Valerie Clinard, PharmD; Jennifer D. Smith, PharmD, CPP, BC-ADM, CDE


US Pharmacist 

In This Article

Abstract and Introduction


Adverse drug reactions (ADRs) are a major health concern, and occur in 0.1% to 1% of patients taking systemic medications.[1,2] The incidence of fatalities due to all drug reactions for hospitalized patients has been documented to be 0.3%.[2] The skin is the largest organ in the body, and adverse skin reactions due to drug exposure are a common problem. Approximately 2% of drug-induced skin eruptions meet the World Health Organization definition of a serious reaction.[1,3] The exact mechanism for many of the drug-induced cutaneous diseases is not fully understood and may result from both immune and nonimmune mechanisms. Properties of a drug that increase the risk of a drug-induced hypersensitivity reaction are: 1) molecular weight >4,000 Da (e.g., insulin, erythropoietin); 2) presence of foreign proteins or large polypeptides of nonhuman origin (streptokinase, beef or pork insulin, chimeric/murine-derived monoclonal antibodies); or 3) the ability of the parent drug or its active metabolite to bind to a carrier protein and form a complete antigen (penicillins and sulfonamides).[4]

Drug-induced skin disorders are often classified as either acute or chronic. Acute diseases include erythematous eruptions; urticaria, angioedema, and anaphylaxis; fixeddrug eruptions; hypersensitivity syndrome; Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN); warfarin-induced skin necrosis; vasculitis; serum sickness–like reaction; acute generalized exanthematous pustulosis (AGEP); and photosensitivity. Chronic disorders include drug-induced lupus, drug-induced acne, and pigmentary changes.


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