What are the guidelines for the management of drug-induced rashes in primary care?

Management of drug-induced rashes in primary care involves the following steps:

• Assessment: Take a detailed history and perform a clinical examination to identify the rash and its timing relative to drug exposure, considering common allergic patterns such as widespread red macules or papules appearing 6–10 days after first exposure or within 3 days of re-exposure (non-immediate reactions without systemic involvement) ¹.
• Consider drug allergy: Suspect drug allergy if the rash occurred during or after drug use, especially if the drug is known to cause such reactions or if there is a history of similar reactions to the drug or drug class ¹.
• Stop the suspected drug: Discontinue the drug suspected to have caused the rash and advise the patient to avoid it in the future ¹.
• Treat symptoms: Manage acute symptoms as needed; mild rashes may be managed symptomatically in primary care, but severe reactions require urgent hospital referral ¹.
• Documentation and information: Document the suspected drug allergy in the patient’s medical records and provide the patient with clear information about the suspected allergy, including drugs to avoid and advice to check with pharmacists before taking any over-the-counter medications ¹.
• Referral: Refer patients to specialist drug allergy services if they have severe non-immediate cutaneous reactions such as drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens–Johnson syndrome, or toxic epidermal necrolysis ¹.

Additional advice: Patients should be advised to carry information about their drug allergy at all times and share it with healthcare professionals when prescribed or administered drugs ¹.