From the Guidelines
The treatment for a polymorphous rash should be guided by its underlying cause, with a focus on reducing inflammation, controlling itching, and preventing further irritation, as outlined in the management of skin reactions 1. When considering the treatment for a polymorphous rash, it's crucial to identify the underlying cause, as the term "polymorphous" describes a rash with multiple appearances rather than a specific condition.
- For rashes that may be related to or resemble those induced by EGFR inhibitors, treatments that should be avoided include greasy creams for basic care, manipulation of the skin, hot blow-drying of the hair, wearing of tight shoes, topical acne medications, and topical steroids, unless under the supervision of a dermatologist 1.
- Topical corticosteroids, such as prednicarbate cream, can be used to treat inflammatory skin conditions like eczema and fissures that may develop on xerotic skin 1.
- For pruritus or itching, skin moisturizers and urea- or polidocanol-containing lotions are suitable, and systemic treatment with oral H1-antihistamines like cetirizine, loratadine, or fexofenadine may provide relief 1.
- Prevention of further irritation and infection is key, and this can include avoiding dehydrating body care, applying emollients, and using oil-in-water creams or ointments instead of alcohol-containing lotions or gels 1. Given the potential for secondary infection, especially with Staphylococcus aureus, and the importance of treating xerotic and eczematous skin, a comprehensive approach to managing the rash is necessary, considering the avoidance of certain treatments and the use of specific topical and systemic therapies as needed 1.
From the FDA Drug Label
4 Dermatologic Diseases Pemphigus Bullous dermatitis herpetiformis Severe erythema multiforme (Stevens-Johnson syndrome) Exfoliative dermatitis Mycosis fungoides Severe psoriasis Severe seborrheic dermatitis 5 Allergic States Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment: Seasonal or perennial allergic rhinitis Bronchial asthma Contact dermatitis Atopic dermatitis Serum sickness Drug hypersensitivity reactions
The treatment for a polymorphous rash may involve prednisone (PO), as it is indicated for severe erythema multiforme (Stevens-Johnson syndrome), which can be a type of polymorphous rash. However, the specific diagnosis and treatment should be determined by a healthcare professional. 2
From the Research
Treatment for Polymorphous Rash
The treatment for a polymorphous rash can vary depending on the underlying cause and severity of the condition.
- For allergic reactions, treatment may involve the use of epinephrine, corticosteroids, and antihistamines 3.
- In cases of eczematous drug eruptions, treatment may include emollients, topical corticosteroids, and oral antihistamines 4.
- For erythema multiforme, treatment is highly variable and depends on the etiology, involvement of mucosal sites, and chronicity of the disease 5.
- If the etiology or causal medication/infection is identified, treatment involves stopping the medication and/or treating the infection prior to initiating symptomatic treatment 5.
- Symptomatic treatment for acute erythema multiforme focuses on relieving symptoms with topical steroids or antihistamines 5.
- Treatment for recurrent erythema multiforme is most successful when tailored to individual patients, and may include systemic and topical therapies such as corticosteroid therapy, antiviral prophylaxis, high-potency corticosteroids, and antiseptic or anesthetic solutions for mucosal involvement 5.
Diagnosis and Assessment
Diagnosing the underlying cause of a polymorphous rash is crucial for effective treatment.
- A thorough history and physical examination, followed by consideration of red flags, are essential in diagnosing and managing rashes 6.
- Rashes can be categorized into different morphologic groups, such as petechial/purpuric, erythematous, maculopapular, and vesiculobullous, to help narrow down the potential causes 6.
- The presence of fever and systemic signs of illness should also be assessed to determine the severity of the condition 6.