Can Doxycycline Cause Palmar Erythema and Rash?
Yes, doxycycline can cause both palmar erythema and various types of rashes, though these are uncommon adverse effects that typically resolve with drug discontinuation.
Documented Cutaneous Reactions to Doxycycline
Doxycycline is associated with multiple cutaneous adverse reactions to the drug (CARD), including:
Palmar Involvement
- Bullous fixed drug eruption affecting the palms has been documented, presenting as erythematous, purplish annular patches with overlying bullae and hemorrhagic content on both palms within 24 hours of doxycycline initiation 1
- The bullous eruption on palms was confirmed through pharmacovigilance investigation and skin biopsy showing hydropic degeneration of the basal membrane with lymphocytic and eosinophilic infiltrate 1
Common Rash Patterns
- Morbilliform exanthem is one of the most common cutaneous reactions to doxycycline, which can occur simultaneously with other skin reactions 2
- Photosensitivity reactions are frequently reported, and dual CARD presentations (photosensitivity plus morbilliform eruption occurring together) have been documented 2
- Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) presents as symmetric, pruritic, erythematous papules over flexural regions, neck, and inframammary areas, typically appearing 2 weeks after starting doxycycline 3
Less Common Reactions
- Drug-induced subacute cutaneous lupus erythematosus (SCLE) manifesting as scaly, erythematous, annular papules and plaques on chest, back, arms, and legs has been reported after doxycycline exposure 4
- Other uncommon reactions include bullous eruptions, lupus-like eruptions, pigmentary disorders, and vasculitis 2
Clinical Management Algorithm
Immediate Actions
- Discontinue doxycycline immediately upon recognition of cutaneous eruption 2, 1, 3
- Obtain skin biopsy if diagnosis is uncertain or if severe bullous eruption is present 1
Treatment Approach
- Topical corticosteroids (low to moderate strength) for localized eruptions 2, 3
- Oral corticosteroids for more extensive or severe reactions 2
- Symptomatic management of pruritus as needed 3
- Resolution typically occurs within 2 weeks of drug discontinuation and initiation of corticosteroid therapy 2, 3
Important Clinical Pitfalls
Timing of onset varies significantly: Reactions can develop within 24 hours (as with bullous fixed drug eruption) 1 or take up to 2 weeks (as with SDRIFE) 3, or even months (as with drug-induced SCLE) 4. Do not rule out doxycycline as the causative agent based solely on timing.
Dual presentations can occur: A patient may develop two different cutaneous reactions simultaneously, such as photosensitivity and morbilliform exanthem occurring together 2. Examine the entire skin surface, not just the presenting area.
Consider pharmacovigilance reporting: When doxycycline-induced cutaneous reactions are confirmed, formal pharmacovigilance investigation should be conducted 1.