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Sulfonamide medications can cause different types of allergic or “hypersensitivity” reactions. A common type of reaction—type IV—is caused by a component of sulfonamide antibiotic preparations not present in topical sulfa preparations. These reactions typically include a delayed onset rash and itching, and wouldn’t preclude use of topical preparations for acne. If the reaction to sulfa medications includes hives, low blood pressure, or trouble breathing—a type 1 reaction—all antimicrobial preparations containing sulfa should be avoided.