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Chapter 38: Morbilliform Drug Reactions

INTRODUCTION

KEY POINTS

  • Morbilliform eruptions tend to present with diffuse papules coalescing into plaques.

  • In darker skin, these papules are often violaceous to dark brown with minimal to no visible background erythema.

  • In contrast, lighter skin tends to show bright pink to red papules with a marked background of erythema.

  • In both cases, there can be little to no sparing of normal skin.

image

FIGURE 38-1.

Diffuse and densely scattered bright-pink macules and confluent papules on the back. (Reproduced with permission from Burgin S. Guidebook to Dermatologic Diagnosis. New York, NY: McGraw Hill; 2021, Figure 10-13.)

A photo of the back of a patient with a morbilliform shows tiny, red spots evenly spread over the entire back.
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FIGURE 38-2.

Magenta-colored papules and confluent plaques covering the majority of the back in a person of color. (From Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 35-1. Reproduced with permission from Lisa Pappas-Taffer, MD.)

A patient with brown skin exhibits a dense concentration of deep red papules coalescing into plaques and covering the majority of the back. The skin beneath is reddened.
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FIGURE 38-3.

Densely scattered violaceous and brown macules and papules over a background of subtle erythema in a person with dark skin. (From Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 35-3. Reproduced with permission from Lisa Pappas-Taffer, MD.)

A patient with dark brown skin exhibits hyperpigmented dark brown macules and red to violent papules on the back, particularly the medial back. The entire background skin is reddened.
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