From the Guidelines
Maculopapular rashes in geriatric patients are most commonly caused by drug reactions, viral exanthems, and contact dermatitis, and require prompt evaluation and treatment to prevent serious complications. The initial approach should include a thorough medication review, as drug reactions are common causes in older adults, particularly antibiotics (especially beta-lactams, sulfonamides), allopurinol, and antiepileptics 1. Treatment begins with discontinuing suspected medications and providing symptomatic relief with topical corticosteroids like triamcinolone 0.1% cream applied twice daily for 7-10 days. For moderate to severe cases, oral antihistamines such as cetirizine 10mg daily or diphenhydramine 25mg every 6 hours may help with itching, though diphenhydramine should be used cautiously due to anticholinergic effects in older adults.
Some key causes of maculopapular rashes in geriatric patients include:
- Drug reactions: particularly antibiotics, allopurinol, and antiepileptics 1
- Viral exanthems: such as herpes zoster, which requires special attention in the elderly; acyclovir 800mg five times daily for 7-10 days should be started if herpes zoster is suspected 1
- Contact dermatitis: which can be caused by allergens such as metals, chemicals, and plastics, and can be treated with topical steroids or calcineurin inhibitors 1
- Other common causes: such as scabies (treated with permethrin 5% cream), and autoimmune conditions like bullous pemphigoid
Age-related skin changes in geriatric patients, including decreased barrier function, reduced immune response, and polypharmacy, make them more susceptible to rashes and can alter presentation, often making diagnosis challenging 1. Careful monitoring is essential as elderly patients have higher risks of complications from both the rash itself and treatments. Rashes can also be a sign of underlying serious conditions, such as Rocky Mountain spotted fever, which can present with a maculopapular rash and requires prompt treatment 1.
From the Research
Causes of Maculopapular Rash in Geriatric Patients
The causes of maculopapular rash in geriatric patients can be varied and include:
- Drug allergies: Certain medications such as pregabalin 2, colistin 3, and carbamazepine 4 have been reported to cause maculopapular eruptions in elderly patients.
- Infection-related: Viral exanthems, scarlet fever 5, and brucellosis 6 are examples of infections that can cause maculopapular rashes.
- Autoimmune conditions: Still's disease 5 is an example of an autoimmune condition that can cause maculopapular eruptions.
Medication-Induced Maculopapular Rash
Medications are a common cause of maculopapular rash in geriatric patients, with examples including:
- Pregabalin: A case report described a maculopapular eruption induced by pregabalin in an elderly male 2.
- Colistin: A rare case of colistin-induced maculopapular rash was reported in an 84-year-old male 3.
- Carbamazepine: A case report described a maculopapular rash and angioedema secondary to carbamazepine administration 4.
Infection-Related Maculopapular Rash
Infections can also cause maculopapular rashes in geriatric patients, with examples including: