Cutaneous Adverse Drug Reactions (CADRs) between Aromatic and Non-Aromatic Antiepileptic Drugs: Clinical Presentation and Severity

2020 ◽  
Vol 103 (10) ◽  
pp. 1017-1021
Keyword(s):  
Antiepileptic Drugs ◽  
Adverse Drug Reactions ◽  
Drug Hypersensitivity ◽  
Common Adverse Effect ◽  
Drug Reactions ◽  
Johnson Syndrome ◽  
Significant Difference ◽  
Cutaneous Drug Reactions ◽  
Steven Johnson Syndrome ◽  
Systemic Symptoms

Background: Drug hypersensitivity is the most common adverse effect of drug use. Major cutaneous adverse drug reactions (CADRs) represent the higher rates of morbidity and mortality, with up to 5.2% of cases. Current reports revealed the non-aromatic antiepileptic drugs had increasing rates of CADRs from the past. Objective: To study the clinical presentations and the severity of CADRs due to aromatic and non-aromatic antiepileptic drugs. Materials and Methods: A retrospective cohort study was conducted with inpatients and outpatients with CADRs receiving antiepileptic drugs in Phramongkutklao Hospital between January 2009 and December 2018. Results: Among 77 patients with CADRs, 61 patients received aromatic antiepileptic drugs and 16 patients took non-aromatic antiepileptic drugs. Among the patients with aromatic antiepileptic drugs 52.46% developed minor cutaneous drug reactions. The rest, 47.54%, developed major cutaneous drug reactions including Steven-Johnson syndrome or toxic epidermal necrolysis (SJS/TEN) 13.11% and drug rash with eosinophil and systemic symptoms (DRESS) 31.15%. Among the patients with non-aromatic antiepileptic drugs, 62.5% developed minor cutaneous drug reactions. The rest, 37.5%, developed major CADRs including SJS/TEN 12.5% and DRESS 25%. Of the patients receiving aromatic antiepileptic, the major CADRs group showed significant higher level of eosinophil compared with minor CADRs (10.35% and 2.1%, respectively, p<0.001). The study showed significant higher alkaline phosphatase (ALP) levels in 138.5 IU/L among patient with major CADRs who received aromatic antiepileptic drugs compared with minor CADRs in 87 IU/L (p=0.006). No significant difference of laboratory was found among CADRs patients in non-aromatic group. Conclusion: Aromatic antiepileptic drugs tended to cause more severe cutaneous drug reactions than non-aromatic antiepileptic drugs, especially DRESS. The internal organ involvements were significantly identified in the aromatic antiepileptic group regarding to serum eosinophil and ALP level. Keywords: Adverse skin reaction, Aromatic antiepileptic drugs, Non-aromatic antiepileptic drug

scholarly journals Severe Cutaneous Adverse Drug Reactions in Bangladesh: A Review in a Tertiary Level Hospital

2016 ◽  
Vol 12 (2) ◽  
pp. 71-75
Author(s):  
Md Niamul Gani Chowdhury ◽  
Mohammad Enamul Hoque ◽  
Md Abdul Latif Khan ◽  
Md Shirajul Islam Khan
Keyword(s):  
Adverse Drug Reactions ◽  
Armed Forces ◽  
Stevens Johnson Syndrome ◽  
Military Hospital ◽  
Case Report Form ◽  
Drug Reactions ◽  
Female Ratio ◽  
Medical College ◽  
Johnson Syndrome ◽  
Systemic Symptoms

Introduction: The Severe Cutaneous Adverse Drug Reactions (SCADRs) are rare but life-threatening as these encompass drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and acute generalized exanthematous pustulosis (AGEP). Objective: To estimate the incidence of SCADRs and to find out the cause in Bangladesh. Materials and Methods: 50 patients with SCADRs were studied over a period of 1 year from January 2015 to December 2015 in the Department of Dermatology, Combined Military Hospital, Dhaka. Data were collected from the informant and recorded in structured Case Report Form. Quantitative data were expressed as mean and standard deviation and qualitative data as frequency and percentage. Results: Clinical diagnosis of the study subjects recognized 46.0% cases as SJS, 28(19.0%) as TEN, 16.0% as DRESS and 10.0% as AGEP. The maximum incidence (46%) was seen in the age group of 31-50 years; mean age of the patient was 37.42+5.3 years. Male and female ratio was 2.84:1. Anticonvulsant group of drugs could give rise to maximum incidence of SCADRs. Carbamazepine was responsible in 22.0% cases of SCADRs, followed by Phenytoin in 16.0% patients and Phenobarbital in 14.0% cases. Conclusion: SCADRs were seen mostly with the anticonvulsant drugs belonging to Carbamazepine and Phenytoin group. SCADRs deserve continuous monitoring to plan preventive strategies. Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 71-75

scholarly journals Dermoscopic Aspects of Cutaneous Adverse Drug Reactions

2021 ◽  
pp. e2021136
Author(s):  
Gabriela Rossi ◽  
André Da Silva Cartell ◽  
Renato Marchiori Bakos
Keyword(s):  
Adverse Drug Reactions ◽  
Adverse Reactions ◽  
Stevens Johnson Syndrome ◽  
Drug Reactions ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Johnson Syndrome ◽  
Vascular Structures ◽  
Systemic Symptoms ◽  
Exanthematous Pustulosis ◽  
Cutaneous Adverse Reactions

Background: Little is known about the dermoscopic evaluation of cutaneous adverse drug reactions (CADRs). Objectives: To evaluate the dermoscopic patterns of CADRs and identify those associated with severe cutaneous adverse reactions to drugs (SCARDs). Patients and Methods: Patients included in this study from May 2015 to April 2016 had presented with CADRs. CADR presentation and classification were based on standard criteria. SCARDs included Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), overlap SJS/TEN, drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP). The dermoscopic features of CADRs were described and compared according to the severity of the reactions. Results: Sixty-nine patients were included. Sixteen patients (23.2%) presented SCARDs. The main dermoscopic findings in SJS, overlap SJS/TEN and TEN were black dots or necrotic areas (100%). Erosion [respectively, 4/6 (66.7%), 3/3 (100%) and 1/1 (100%)], necrotic borders [respectively, 4/6 (66.7%), 3/3 (100%) and 1/1, (100%)] and epidermal detachment [respectively, 5/6 (83.3%); 2/3 (66.7%) and 1/1 (100%)] were also common among these reactions. Erythema and purpuric dots were the main dermoscopic findings [respectively, 5/6 (83.3%) and 4/6 (66.7%)] in DRESS. In non-severe reactions, the most prevalent structures were erythema and purpura in exanthema [respectively, 31/33 (93.9%) and 24/33 (72.7%)] and erythema and vascular structures in urticarial reactions [respectively, 6/6 (100%) and 3/6 (50%)]. Black dots or necrotic areas, epidermal detachment, necrotic borders and erosion were highly associated with SCARDs (P < 0.001). Conclusions: Dermoscopy improves clinical recognition of SCARDs.

Ciprofloxacin-Induced Bullae of the Lower Extremity: A Case of a Fixed Drug Reaction

2019 ◽  
Vol 109 (2) ◽  
pp. 155-158 ◽  
Author(s):  
Anthony J. Mollica ◽  
Albert J. Mollica ◽  
Elaine Grant ◽  
Ali Malik ◽  
Marc Claydon
Keyword(s):  
Drug Reaction ◽  
Adverse Drug Reactions ◽  
Hypersensitivity Syndrome ◽  
Stevens Johnson Syndrome ◽  
Adverse Side Effect ◽  
Drug Reactions ◽  
Johnson Syndrome ◽  
Fixed Drug ◽  
Cutaneous Drug Reactions ◽  
Exanthematous Pustulosis

Cutaneous adverse drug reactions make up 1% to 2% of all adverse drug reactions. From these adverse cutaneous drug reactions, 16% to 21% can be categorized as fixed drug reactions (FDR). Fixed drug reactions may show diverse morphology including but not limited to the following: dermatitis, Stevens-Johnson syndrome, urticaria, morbilliform exanthema, hypersensitivity syndrome, pigmentary changes, acute generalized exanthematous pustulosis, photosensitivity, and vasculitis. An FDR will occur at the same site because of repeated exposure to the offending agent, causing a corresponding immune reaction. There are many drugs that can cause an FDR, such as analgesics, antibiotics, muscle relaxants, and anticonvulsants. The antibiotic ciprofloxacin has been shown to be a cause of cutaneous adverse drug reactions; however, the fixed drug reaction bullous variant is rare. This case study was published to demonstrate a rare adverse side effect to a commonly used antibiotic in podiatric medicine.

A CLINICAL STUDY OF CUTANEOUS ADVERSE DRUG REACTIONS IN TERTIARY CARE HOSPITAL

2021 ◽  
pp. 24-26
Author(s):  
Jaydip Tank ◽  
Radha Dhudshia ◽  
Mitesh Thakkar ◽  
Bela Shah
Keyword(s):  
Adverse Drug Reactions ◽  
Tertiary Care ◽  
Care Hospital ◽  
Drug Reactions ◽  
Fixed Drug Eruption ◽  
Cutaneous Eruption ◽  
Johnson Syndrome ◽  
Culprit Drug ◽  
Fixed Drug ◽  
Steven Johnson Syndrome

The patterns of cutaneous eruption and the offending agent vary amongst the different population previously studied. This study aims to determine the different clinical patterns of cutaneous adverse drug reactions (CADRs) in our population and recognize the common drug implicated. A prospective observational study was conducted over a period of two years recording various CADRs. Out of the 630 patients, common reactions observed were Fixed drug eruption (25.71%), Urticaria / Angioedema (21.27%), Exanthematous rash(15.87%), Erythema multiforme(3.81%), Steven-Johnson Syndrome (4.13%) and Toxic epidermal necrolysis (2.07 %). The most common pharmacological group was Antimicrobials (37.01%), NSAIDS (16.64%), Anticonvulsants (7.61%) and Antiretroviral therapy (12.52%). Cotrimoxazole was the culprit in 11.11%, Nevirapine in 9.36%, Amoxycillin in 7.61% and Phenytoin in 5.23% of patients. 10 patients of TEN proved to be fatal. Among 15.56% HIV reactive patients, the most common pattern was exanthematous rash (45.91%) with Nevirapine(59.20%) as the most common culprit drug.

scholarly journals Immunohistopathological Findings of Severe Cutaneous Adverse Drug Reactions

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Mari Orime
Keyword(s):  
Adverse Drug Reactions ◽  
Clinical Manifestations ◽  
Hypersensitivity Syndrome ◽  
Conclusive Evidence ◽  
Stevens Johnson Syndrome ◽  
Drug Reactions ◽  
Drug Induced ◽  
Cutaneous Manifestations ◽  
Johnson Syndrome ◽  
Systemic Symptoms

Diagnosis of severe cutaneous adverse drug reactions should involve immunohistopathological examination, which gives insight into the pathomechanisms of these disorders. The characteristic histological findings of erythema multiforme (EM), Stevens–Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) provide conclusive evidence demonstrating that SJS/TEN can be distinguished from EM. Established SJS/TEN shows full-thickness, extensive keratinocyte necrosis that develops into subepidermal bullae. Drug-induced hypersensitivity syndrome (DIHS) and exanthema in drug reaction with eosinophilia and systemic symptoms (DRESS) each display a variety of histopathological findings, which may partly correlate with the clinical manifestations. Although the histopathology of DRESS is nonspecific, the association of two or more of the four patterns—eczematous changes, interface dermatitis, acute generalized exanthematous pustulosis- (AGEP-) like patterns, and EM-like patterns—might appear in a single biopsy specimen, suggesting the diagnosis and severe cutaneous manifestations of DRESS. Cutaneous dendritic cells may be involved in the clinical course. AGEP typically shows spongiform superficial epidermal pustules accompanied with edema of the papillary dermis and abundant mixed perivascular infiltrates. Mutations in IL36RN may have a definite effect on pathological similarities between AGEP and generalized pustular psoriasis.

Cutaneous Drug Reactions in Children Attending a Tertiary Care Hospital

2020 ◽  
Vol 33 (2) ◽  
pp. 56-62
Author(s):  
Md Mostafizur Rahman ◽  
Md Azraf Hossain Khan ◽  
Pampa Chandra ◽  
Laila Shamima Sharmin ◽  
Fazlur Rahman ◽  
...  
Keyword(s):  
Drug Reaction ◽  
Adverse Drug Reactions ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Stevens Johnson Syndrome ◽  
Care Hospital ◽  
Drug Reactions ◽  
Johnson Syndrome ◽  
Cutaneous Drug Reactions ◽  
Cutaneous Drug Reaction

Background: Cutaneous drug reaction (CDR) is a growing health hazard in the world. Adverse drug reactions are common complications in drug therapy. About 3-8% of all hospital admissions are the results of adverse drug reactions, among them 2-3% are children and these can cause significant disability to patients. Early identification and management of adverse cutaneous drug reaction has both short term and long term prognostic significance.  Objective: To know the cutaneous reaction to drugs in children in a tertiary care hospital.  Study design: Hospital based descriptive, observational study. Subjects: 50 children with cutaneous drug reactions were studied in the department of Dermatology and Pediatric respectively in Rajshahi Medical College Hospital, Rajshahi. Methods: Data were collected by detailed history taking, physical examination and laboratory investigations in a prefixed data collection sheet and with the help of GOLD guideline after taken informed consent of the patient. Results: This study showed a significant male predominance. Male: female ratio was 1.08:1 .In this study prevalence was highest among 1-5 years age group. Cotrimoxazole, NSAIDs, anticonvulsant and quinolone were most offending medications. Maculopapular eruption, Stevens Johnson Syndrome, fixed drug eruption and urticaria were most common morphological types. Majority of CDRs were noted with oral route of administration. It was observed that almost all the CDRs that were reported involved mainly the skin. Majority of adverse cutaneous drug reactions reported were moderate in severity. Conclusion: Frequency distribution of the offending drugs and the adverse reactions revealed that adverse cutaneous drug reactions occurred mostly by cotrimoxazole, NSAIDs and quinolones. Maculopapular rash and Stevens Johnson Syndrome were the most common morphological types. A better understanding of the mechanisms underlying CRDs is important in drug development and in patient care. TAJ 2020; 33(2): 56-62

scholarly journals A Comprehensive Review of HLA and Severe Cutaneous Adverse Drug Reactions: Implication for Clinical Pharmacogenomics and Precision Medicine

2021 ◽  
Vol 14 (11) ◽  
pp. 1077
Author(s):  
Chiraphat Kloypan ◽  
Napatrupron Koomdee ◽  
Patompong Satapornpong ◽  
Therdpong Tempark ◽  
Mohitosh Biswas ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Precision Medicine ◽  
Adverse Drug Reactions ◽  
Drug Hypersensitivity ◽  
Human Leukocyte ◽  
Population Level ◽  
Stevens Johnson Syndrome ◽  
Drug Reactions ◽  
Drug Induced ◽  
Systemic Symptoms

Human leukocyte antigen (HLA) encoded by the HLA gene is an important modulator for immune responses and drug hypersensitivity reactions as well. Genetic polymorphisms of HLA vary widely at population level and are responsible for developing severe cutaneous adverse drug reactions (SCARs) such as Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), maculopapular exanthema (MPE). The associations of different HLA alleles with the risk of drug induced SJS/TEN, DRESS and MPE are strongly supportive for clinical considerations. Prescribing guidelines generated by different national and international working groups for translation of HLA pharmacogenetics into clinical practice are underway and functional in many countries, including Thailand. Cutting edge genomic technologies may accelerate wider adoption of HLA screening in routine clinical settings. There are great opportunities and several challenges as well for effective implementation of HLA genotyping globally in routine clinical practice for the prevention of drug induced SCARs substantially, enforcing precision medicine initiatives.

scholarly journals Monitoring cutaneous adverse drug reactions in patients on TDF+3TC+EFV: a single centre experience

2017 ◽  
Vol 6 (6) ◽  
pp. 1467
Author(s):  
Nikhil Era ◽  
Shatavisa Mukherjee ◽  
Bibhuti Saha ◽  
Santanu Kumar Tripathi
Keyword(s):  
Adverse Drug Reactions ◽  
Treatment Options ◽  
Maculopapular Rash ◽  
Outpatient Setting ◽  
Drug Reactions ◽  
First Line ◽  
Johnson Syndrome ◽  
Set Up ◽  
Steven Johnson Syndrome ◽  
One Year

Background: HIV-infected patients initiating antiretroviral therapy may manifest a wide variety of ADRs ranging from trivial manifestation, such as rashes, pigmentation, to severe life‑threatening reactions, such as Steven–Johnson syndrome, toxic epidermal necrolysis. The present study thus monitored cutaneous adverse drug reactions in patients on first line antiretroviral regimen comprising of tenofovir disoproxil fumerate, lamivudine and efavirenz as a three drug-combination.Methods: A prospective observational clinical study was carried out for a period of one year among PLHIV receiving TDF+3TC+EFV as first line regimen in the outpatient setting of a nodal ART centre of eastern India.Results: The major regimen induced dermatological complications presenting in our study set up included rashes, itching, SJS, pigmentation of nails, skin Hyperpigmentation. The morbilliform eruption, often referred to as a maculopapular rash, is the most common type of reaction occurring after treatment initiation.Conclusions: Adverse drug reactions are one of the most common public health concerns, which influence patients' treatment options along with health care costs.

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