A Textbook of Clinical Pharmacology and Therapeutics

418 DRUGS AND THE SKIN

Table 51.6:Adverse effects of drugs on the skin

Cutaneous eruption Drugs commonly associated Comment

Acne Glucocorticosteroids, androgens, anabolic

steroids, phenytoin

Alopecia Cytotoxic chemotherapy, retinoids, gold,

long-term heparin, oral contraceptives,

sodium valproate

Eczema β-Lactams, phenothiazines

Erythema multiforme Sulphonamides, penicillins (β-lactams), Inclusive of Stevens Johnson syndrome

barbiturates, allopurinol, rifampicin,

all NSAIDs, phenytoin, carbamazepine

and lamotrigine

Erythema nodosum Sulphonamides, antimicrobials (especially

β-lactams), oral contraceptives

Exfoliative dermatitis and Allopurinol, carbamazepine, gold,

erythroderma penicillins, phenothiazines

Fixed eruptions Barbiturates, laxatives, phenolphthalein, These eruptions recur at the same site (often

naproxen, nifedipine, penicillins, circumorally) with each administration of the

sulphonamides, tetracyclines, quinidine drug and may be purpuric or bullous

Lichenoid eruptions Captopril, chloroquine, furosemide, gold,

phenothiazines, thiazides

Lupus erythematosus with Hydralazine, isoniazid, phenytoin,

butterfly rash procainamide

Photosensitivity

Systemic drugs Amiodarone, chlorodiazepoxide, furosemide,

griseofulvin, nalidixic acid, thiazides,

tetracyclines, piroxicam

Topical drugs Coal tar, hexachlorophane, p-aminobenzoic

acid and its esters

Pigmentation Amiodarone, chloroquine, oral contraceptives, AZT causes grey nails; chloroquine causes hair

phenothiazines and skin depigmentation

Pruritus Oral contraceptives, phenothiazines, Without any rashes – rifampicin causes biliary

rifampicin stasis

Purpura Thiazides, phenylbutazone, sulphonamides, May be thrombocytopenic or vasculitic

sulphonylureas, quinine

Toxic epidermal necrolysis NSAIDs, penicillins (β-lactams), phenytoin,

sulphonamides

Toxic erythema Ampicillin, sulphonamides, sulphonylureas, Usually occurs after 7–9 days of therapy or after

furosemide, thiazides 2–3 days in those previously exposed

Urticaria

Acute Radiocontrast media

Acute/chronic Aspirin (NSAIDs), ACE inhibitors, gold,

penicillins

Vasculitis – allergic NSAIDs, phenytoin, sulphonamides, thiazides,

penicillins and retinoids

NSAIDs, non-steroidal anti-inflammatory drugs; ACE, angiotensin-converting enzyme; AZT, azidothymidine.