Cristina Coiman 1, Yara Shhab 1 *, Diana Ana-Maria Nitescu 1, Smaranda Stoleru 1, Ion Fulga 1, Oana Andreia Coman 1
1 Department of Pharmacology, Clinical Pharmacology and Pharmacotherapy, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
* Correspondence to: Yara Shhab, Department of Pharmacology, Clinical Pharmacology and Pharmacotherapy, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. E-mail: yarashhab2@gmail.com
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are among the most commonly prescribed and self-administered medications worldwide, owing to their analgesic, antipyretic, and anti-inflammatory properties. Despite their broad therapeutic utility, both drug classes are frequently associated with cutaneous adverse reactions, ranging from mild, self-limiting eruptions to severe, potentially life-threatening dermatoses. Cutaneous involvement represents one of the most common manifestations of drug intolerance and often serves as an early indicator of adverse drug reactions. This narrative review summarizes the mechanisms, clinical patterns, and diagnostic approaches to cutaneous reactions induced by NSAIDs and corticosteroids. NSAID-related cutaneous reactions arise through both immunologic and non-immunologic mechanisms, most commonly related to cyclooxygenase inhibition and subsequent alterations in arachidonic acid metabolism. These reactions include frequent phenotypes such as urticaria and maculopapular eruptions, as well as less common but severe manifestations, including Stevens–Johnson syndrome and toxic epidermal necrolysis. Recent advances in the classification of NSAID hypersensitivity have emphasized the distinction between pharmacological cross-reactivity and true immune-mediated hypersensitivity, as well as the recognition of overlapping clinical phenotypes. Cutaneous adverse effects of corticosteroids are predominantly driven by their pharmacologic impact on skin structure and immune function. Prolonged exposure, particularly to high-potency topical formulations, may result in skin atrophy, striae, telangiectasia, acneiform eruptions, and increased susceptibility to cutaneous infections. Although less common, immediate and delayed hypersensitivity reactions to corticosteroids—including allergic contact dermatitis—have been documented and may complicate diagnosis due to partial masking by their intrinsic anti-inflammatory effects. This review also addresses the potential exacerbation of pre-existing dermatologic conditions, the importance of chronological and morphological pattern analysis, and the principles of structured drug-related rash assessment. Accurate recognition of cutaneous drug reactions, combined with systematic diagnostic approaches, is essential to guide appropriate management, prevent severe outcomes, and optimize patient safety in clinical practice.