Identification and Treatment of Drug-Induced Skin Reactions for the Urgent Care Clinician (Pharmacology CME)

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Delivery Method:	Online
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Publication Date: July 2026 (Volume 5, Number 7)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 07/01/2029.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 1 Pharmacology CME credit, subject to your state and institutional approval.

Authors

Abstract

Drug exanthems are a common reason for presentation to urgent care. While some drug reactions can be safely managed in an outpatient setting, others are associated with significant morbidity and mortality. Prompt identification of life-threatening conditions is critical for optimal outcomes. This review provides recommendations for the diagnosis, treatment, and disposition of patients presenting with drug exanthems, with a focus on exanthematous drug reactions, drug-induced hypersensitivity syndrome, and Stevens-Johnson syndrome/toxic epidermal necrolysis. Particular attention is given to recognition of “red flag” signs and symptoms that should prompt escalation to a higher level of care.

Case Presentations

A 9-year-old boy presents with a widespread, itchy rash...

• He completed a 7-day course of amoxicillin for otitis media 2 days previously.
• He developed an itchy rash 1 day ago. He denies vision changes, trouble urinating, and sores in the mouth. He also denies lip or tongue swelling, wheezing, shortness of breath, and dizziness.
• He is afebrile. The physical examination reveals a widespread, morbilliform reaction covering 50% body surface area. The rash is focused on the trunk and extremities, with sparing of the face. There is no facial swelling. Ocular conjunctiva appears normal. There is no lymphadenopathy. Breath sounds are normal without wheezes or rhonchi.
• An oral examination does not reveal erosions or edema of the lips or tongue.
• You consider what testing is necessary, and what treatment may provide symptomatic relief…

A 52-year-old woman presents with fever, ocular and oral erosions, and a painful, blistering rash on her chest and upper back…

• The rash started 2 days earlier on her face and spread to her chest and upper back.
• The patient has also been experiencing fevers >102˚F and generally feels unwell.
• Since yesterday, she has noted eye and mouth pain, blurry vision, and difficulty swallowing.
• The patient was seen 2 weeks earlier for a urinary tract infection (UTI), which was treated with a course of trimethoprim sulfamethoxazole. She reports that the dysuria associated with the UTI had resolved following her course of antibiotics but returned within the last day.
• You wonder if her current condition is related to the UTI treatment…

A 14-year-old girl presents with several days of a diffuse rash, fevers, and malaise…

• She takes valproic acid and lamotrigine for epilepsy. Lamotrigine was added 6 weeks ago at a starting dose of 25 mg daily, with increase to 50 mg daily at week 2 and 50 mg twice daily at week 3.
• The rash began 5 days ago and has spread to involve approximately 60% body surface area. She feels “swollen.”
• She is febrile at 102˚F. The physical examination reveals a widespread, morbilliform reaction concentrated on the upper trunk, upper extremities, and face, with a purpuric discoloration. There is axillary and cervical lymphadenopathy with approximately 1- to 2-cm nodes palpated. Modest facial and hand edema are noted.
• You wonder what best explains this constellation of symptoms, what testing is indicated, and how management should proceed...

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