From the Guidelines
For drug-related rashes, topical moderate/high-potency steroids are the most effective ointment treatment, as recommended by the most recent and highest quality study 1. The treatment of drug-related rashes depends on the severity of the reaction.
- For mild or localized reactions, topical moderate/high-potency steroids are recommended, with reassessment after 2 weeks to determine if the reaction has improved or worsened 1.
- For more severe reactions, oral antihistamines or GABA agonists may be added to the treatment regimen, in addition to topical corticosteroids 1.
- It is essential to discontinue the suspected medication if possible and consult a healthcare provider, especially if the rash is widespread, painful, involves mucous membranes, or is accompanied by fever or difficulty breathing.
- The use of gentle skin care instructions, oral antihistamines, and topical corticosteroids can help prevent and manage pruritus associated with drug-related rashes 1.
- Other treatments, such as calamine lotion and moisturizers containing colloidal oatmeal, may also be beneficial in relieving itching and soothing irritated skin, but the most recent and highest quality study 1 prioritizes topical moderate/high-potency steroids as the first-line treatment.
From the FDA Drug Label
Apply triamcinolone acetonide cream USP, 0. 1% as appropriate, to the affected area two to three times daily. Rub in gently. The triamcinolone acetonide cream USP, 0. 1% may be used for the management of a drug-related rash, such as those associated with psoriasis or other recalcitrant conditions.
- Key points:
- Apply to the affected area two to three times daily.
- Rub in gently.
- May use occlusive dressings for management of recalcitrant conditions 2
From the Research
Treatment Options for Drug-Related Rash
- The treatment of drug-related rash, also known as severe drug eruption, often involves the use of topical corticosteroids, immunoglobulins, systemic corticosteroids, and cyclosporine A 3.
- In some cases, new biologics and plasma exchange may be used as treatment strategies to reduce mortality 3.
- Topical application of antihistamines can lead to sensitization and cutaneous drug eruption, highlighting the importance of assessing patients whose skin condition worsens after treatment with antihistamines 4.
Ointments for Drug-Related Rash
- Ointments are often considered the most effective vehicle for topical corticosteroid treatment due to their occlusive nature and moisturizing ability 5.
- However, studies have shown that non-ointment topical corticosteroid products can exhibit excellent efficacy in clinical practice, and patient preference should be taken into account when selecting a treatment vehicle 5, 6.
- The concentration of corticosteroid in the skin, adjusted for relative potency, may be a predictor of clinical efficacy, and topical corticosteroids can achieve greater effective drug levels in the skin than oral prednisone 6.
Considerations for Treatment
- The choice of treatment vehicle and potency, as well as frequency of application, should be tailored to the individual patient and take into account the duration of treatment and patient preferences 7.
- Topical corticosteroids are a common treatment for atopic dermatitis, and their therapeutic efficacy depends on selecting the appropriate vehicle and potency 7.
- Patient compliance with topical therapy is crucial, and poor compliance can contribute to poor treatment outcomes 5, 6.