GuidelinesIMCI
Drug and Allergic Reactions
IMCI - Skin problems
Fixed Drug Reaction
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Signs
- One or more dark round or oval skin lesions with central vesicles
- The lesions recur on the same spot, and increase in number with each successive attack
Treat
- Stop the offending medication
- In mild cases, apply 1% hydrocortisone for five days
- Discuss all cases with a doctor
Features in HIV Infection
- Could be a sign of reactions to ARVs or clotrimazole
Eczema
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Signs
- Erythematous (red), sometimes scalyplaques found on the face, flexures, trunk and extensors
- Yellow pustules which crust indicate secondary bacterial infection
Treat
- Bath in warm water using soap substitutes only once daily
- Dry skin gently
- Apply Hydrocortisone 1% cream followed by application of moisturizer (emulsifying ointment)
- Treat itching oral chlorphenamine 0.1 mg/kg/dose 6–8 hourly
- Treat secondary infection: Cephalexin, oral, 12–25 mg/kg/dose 6 hourly for 5 days OR: Flucloxacillin, oral, 12–25mg/kg/dose 6 hourly for 5 days.
- Refer if:
- severe acute moist or weeping eczema is present
- no improvement after two weeks
- Secondary herpes infection (eczema herpeticum) is suspected
Features in HIV Infection
- Lesions are numerous and recalcitrant to therapy
Steven Johnson Syndrome (SJS)
Look
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Signs
- Severe and acute reaction due to many drugs, the commonest being cotrimoxazole or nevirapine.
- Lesions involve the skin as well as the mucous membranes (e.g. eyes, mouth and genitalia)
- May start as widespread red irregular rash with or without blisters. The blisters rupture leaving denuded areas of skin
- May cause difficulty in breathing
Treat
- Stop medication
- Refer urgently
- Assess for dehydration and give fluids according to plan A, B or C
- Give pain relief (Paracetamol)
Features in HIV Infection
- May be caused by a number of drugs including nevirapine, cotrimoxazole, efavirenz, antiepileptics, antibiotics, antifungals and traditional medications
- HIV and other infections pre-dispose patients to SJS
Integrated Management of Childhood Illness 2022; Skin problems; Drug and Allergic Reactions
Last checked for updates: June 2023