DR12.5 | Cutaneous Adverse Drug Reaction Primary Care — Summary & Reflection

KEY TAKEAWAYS

Primary care of cutaneous adverse drug reactions (DR12.5) is graded by severity, with one constant rule: stop the culprit drug immediately — the single most important step at every tier, and never re-challenge. Mild reactions (maculopapular rash, urticaria) need drug withdrawal, antihistamines and topical steroids, with adrenaline and transfer for airway angioedema; a fixed drug eruption additionally requires counselling on lifelong avoidance. DRESS requires stopping the drug and its class, baseline blood count and liver/renal function, symptomatic skin care and urgent referral, with systemic corticosteroids left as a specialist decision. SJS/TEN is treated like a major burn: stop the drug, intravenous fluids, gentle non-adherent wound care, warmth, analgesia, nil by mouth and urgent ophthalmology for mucosal/eye involvement, documentation of BSA and SCORTEN, and emergency transfer — without starting systemic corticosteroids or immunomodulators in primary care, as their role is disputed and specialist-led. Across every tier the doctor documents and reports the reaction (pharmacovigilance) and respects the boundary between supportive primary care and specialist therapy.

REFLECT

Picture yourself as the lone doctor in that primary health centre with the man whose skin is beginning to peel, three hours from the nearest burns unit. Reflect on the discipline it takes to do the simple correct things — stop the drug, run fluids, dress the skin gently, keep him warm, call ahead — and to resist the temptation to 'do something more' by starting a steroid whose benefit is unproven. How will you hold the line between confident primary care and overreach when a patient is critically ill and help is far away? And how will you make documenting and reporting the culprit drug — so this never happens to the same patient again — a habit you never skip, however busy the clinic?