Methods for Identifying Culprit Drugs in Cutaneous Drug Eruptions: A Scoping Review

Background Cutaneous drug eruptions are a significant source of morbidity, mortality, and cost to the healthcare system. Identifying the culprit drug is essential; however, despite numerous methods being published, there are no consensus guidelines. Objectives Conduct a scoping review to identify all published methods of culprit drug identification for cutaneous drug eruptions, compare the methods, and generate hypotheses for future causality assessment studies. Eligibility criteria Peer-reviewed publications involving culprit drug identification methods. Sources of evidence Medline, Embase, and Cochrane Central Register of Controlled Trials. Charting methods Registered PRISMA-ScR format protocol on Open Science Forum. Results In total, 109 studies and 26 reviews were included comprising 656,635 adverse drug events, most of which were cutaneous. There were 54 methods of culprit drug identification published, categorized as algorithms, probabilistic approaches, and expert judgment. Algorithms had higher sensitivity and positive predictive value, but lower specificity and negative predictive value. Probabilistic approaches had lower sensitivity and positive predictive value, but higher specificity and negative predictive value. Expert judgment was subjective, less reproducible, but the most frequently used to validate other methods. Studies suggest that greater accuracy may be achieved by specifically assessing cutaneous drug eruptions and using combinations of causality assessment categories. Conclusions Culprit drug identification for adverse drug reactions remains a challenge. Many methods have been published, but there are no consensus guidelines. Using causality assessment methods specifically for cutaneous drug eruptions and combining aspects of the different causality assessment categories may improve efficacy. Further studies are needed to validate this hypothesis.

Cutaneous Adverse Reactions Associated with SARS-CoV-2 Vaccines

Many patients are receiving SARS-CoV-2 vaccinations, which have been associated with a variety of adverse effects. Cutaneous adverse reactions to SARS-CoV-2 vaccinations have been progressively reported, but they have not been reviewed according to their morphological clinical patterns. The objective of this review was to summarize the existing data concerning the cutaneous adverse reactions following SARS-CoV-2 vaccines and group them according to common morphological and pathogenetic patterns. We reviewed the English language literature up to August 15th, 2021, using predefined keywords to identify the relevant studies evaluating cutaneous adverse reactions associated with SARS-CoV-2 vaccines. We search for recurrent morphological patterns sharing clinical signs and symptoms and physio-pathological mechanisms. Timing to onset following the first or booster dose of the vaccine, predisposing conditions, therapeutic management, and outcome were also collected. Among the dermatological manifestations associated with SARS-CoV-2 vaccinations, we distinguished: (1) new onset reactions and (2) flares of preexisting dermatoses. The most common were injection site reactions, affecting 30–70% and generally mild or moderate. Small case series or single case reports included filler reactions, exanthemas, vascular lesions, urticaria, eczematous dermatitis, autoimmune bullous reactions, and severe cutaneous adverse reactions. In addition, the exacerbation of chronic immuno-mediated dermatoses (mainly psoriasis and atopic dermatitis) and reactivations of herpes infection were reported. The cutaneous reactions were generally mild, self-limiting, and resembled common cutaneous drug eruptions and/or COVID-19 skin manifestations.

Dermatology

Infections of the skin?, Skin infestations?, Ulcers?, Rashes?, Dermatitis eczema?, Psoriasis?, Pityriasis rosea?, Lichen planus?, Drug eruptions?, Vasculitis?, Erythema nodosum?, Urticaria?, Erythema multiforme?, Blistering disorders?, Connective tissue diseases?, Disorders of pigmentation?, Skin cancers?, Common cutaneous viral infections?, Varicella zoster virus?, Poxvirus infections?, Cutaneous leishmaniasis?, Lymphoedema elephantiasis?, Lymphatic filariasis?, Onchocerciasis 'river blindness'?, Loiasis Loa loa?, Dracunculiasis Guinea worm?, Other parasites that invade the skin?, Cutaneous larva migrans?, Larva currens?, Podoconiosis?, The non-venereal treponematoses?

Fixed Drug Eruptions Secondary to Fixed Drug Combination (ofloxacin/ornidazole): A Cross Sensitivity Case Report

Background: Fixed drug eruption (FDE) is an erythematous cutaneous patch caused by certain drugs through activation of immunologic reaction in the body. The onset of FDE is 30 minutes to 8 hours and is estimated to occur upto 16-21% of all cutaneous reactions. The irrational combination of fluoroquinolones and nitroimidazole is the most prescribed drug for diarrhea in India, and the drug is found to cause FDE either individually or in combination. Cross sensitivity is the major issue associated with Fluoroquinolones and nitroimidazole. Case repor: Our case is of a 45-year-old male who developed FDE due to a combination product of ofloxacin and ornidazole with past FDE history due to a combination product of norfloxacin and tinidazole. The patient presented with erythematous patches all over the body, swollen lips, mucosal erosion over the buccal cavity, and glans penis. Discussion: The patient was successively treated after the withdrawal of the culprit drug with oral Antihistamines, corticosteroids, and other topical creams and gels, which correlates with the standard management of FDE. Conclusion: Proper prescribing knowledge, documentation of drug allergies, and educating patient about allergic reaction play vital role to prevent future drug related problems.