From the Research
Management of a suspected drug skin reaction to Zoloft (sertraline) should begin with immediate discontinuation of the medication in consultation with the prescribing physician. This is crucial as it can help prevent further progression of the reaction and reduce the risk of morbidity and mortality, as highlighted in a study on severe drug-induced skin reactions 1. For mild reactions like maculopapular rash or urticaria, treatment includes:
- Oral antihistamines such as diphenhydramine (25-50 mg every 6 hours) or cetirizine (10 mg daily)
- Topical corticosteroids like hydrocortisone 1% cream applied to affected areas 2-3 times daily
- Cool compresses and emollient lotions can provide symptomatic relief
For moderate reactions, oral corticosteroids such as prednisone (40-60 mg daily with a taper over 1-2 weeks) may be necessary, as suggested by a review of severe skin complications in patients treated with antidepressants 2. Severe reactions like Stevens-Johnson syndrome or anaphylaxis require immediate emergency care, and the patient should be managed in an intensive care setup for appropriate supportive care and infection control, as recommended in a study on drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome 3. After resolution, the patient should avoid sertraline permanently and consider alternative antidepressants from different classes like bupropion or mirtazapine. Documentation of the reaction in the patient's medical record is essential to prevent future exposure, as emphasized in a study on differential diagnosis of severe cutaneous drug eruptions 4.
It is also important to note that drug reactions can occur due to immune-mediated hypersensitivity or direct pharmacological effects on skin cells, with risk factors including previous drug allergies, autoimmune conditions, and genetic predisposition, as discussed in a study on Stevens-Johnson syndrome-Toxic Epidermal Necrolysis overlap induced by sulfasalazine treatment 5. Therefore, a thorough medical history and monitoring for potential drug interactions are crucial in managing patients with suspected drug skin reactions.