Pediatric Drug Rashes

Drug rashes are the body’s reaction to a certain medicine. The type of rash that occurs depends on the type of medicine that is causing it. Rashes can range from mild to severe.

Drug rashes in children can have several causes. These include:

• Allergic reaction to the medicine
• An immune system reaction to the medicine
• An unwanted side effect of a medicine
• Hypersensitivity to sunlight caused by a medicine

Drug rashes may be severe and require a stay in the hospital.

Drug rashes happen for different reasons. There are no specific risk factors for many causes. But an allergic reaction to one medicine may increase the risk for a drug rash or allergic reaction to another medicine in the same medicine family. Long-term (chronic) health problems may increase a child’s risk of getting a drug rash.

The symptoms of drug rashes can vary. But they may be similar to rashes caused by diseases such as measles. It is important to take your child to their healthcare provider for a diagnosis.

The following are common symptoms of drug rashes and their possible causes.

Symptoms and Possible Causes

• Pimples and red areas that show up most often on the face, shoulders, and chest: Anabolic steroids, corticosteroids, bromides, iodides, hydantoins, lithium, isoniazid, phenytoin, phenobarbital, vitamins B-2, B-6 and B-12
• Red, scaly skin that may thicken and involve the entire body: Antibiotics that have sulfa, penicillins or hydantoins 
• A dark red or purple rash that comes back to the same site on the skin: Antibiotics that have sulfa, tetracycline, or phenolphthalein (also found in certain laxatives)
• Raised red bumps: Aspirin, penicillins, antibiotics that have sulfa and many other medicines
• A flat, red rash that may include spots similar to the measles: Antibiotics that have sulfa, ampicillin, analgesics or barbiturates; but any medicine can cause this rash
• Purple areas on the skin, often on the legs: Some blood-thinners (anticoagulants) and water pills (diuretics)
• Blisters or a hive-like rash on the lining of the mouth, vagina or penis: Antibiotics that have sulfa, other antibiotics, NSAIDs, barbiturates, penicillins

Diagnosing a rash caused by a reaction to drug is difficult. Even a small amount of a drug can cause a major reaction on the skin. In addition, the reaction can happen after the child has been taking a drug for a long period of time.

Your child’s healthcare provider may recommend that your child stop taking a medicine to see if the reaction stops. Other medicines may be used instead.

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

The rash usually clears up if the child stops taking the medicine that is causing the reaction. Other treatment may include taking:

• Corticosteroids
• Antihistamines
• Epinephrine for a severe allergic reaction (anaphylaxis)

Tell your child's healthcare provider right away if your child develops a rash while taking a medicine. Don’t give your child any more medicine until you talk to your child's provider. Allergic reactions can be serious and even fatal. Call your child's healthcare provider right away or call 911 if your child has acute symptoms in addition to the rash, such as:

• Wheezing
• Difficulty breathing
• Tightness in the throat or chest
• Fainting
• Nausea
• Vomiting
• Areas of peeling skin or skin that is raw
• Sores on the eyes, in the mouth or on the genitals
• Any other serious symptoms