Elderly Hospitalised Patients-The Impact of Itch and its Prevalence

<p><b>INTRODUCTION</b>Pruritus in elderly patients can have a significant impact on the quality of life but may be underestimated and poorly addressed by healthcare professionals.</p><p><b>MATERIALS AND METHODS</b>From March to May 2010, a structured interview questionnaire including the Dermatology Life Quality Index (DLQI) was administered to all patients admitted to the geriatric ward in Changi General Hospital, Singapore, except for those with cognitive impairment.</p><p><b>RESULTS</b>A total of 194 patients were enrolled in the study; 94 patients (48.5%) were experiencing itch at the point of the interview; mean DLQI score for patients with itch was 6.7; 35.1% of patients experienced sleep disruption whilst 30.9% reported impairment of concentration levels as a consequence of their itch. Of the patients who had informed their doctor about the problem, 73.7% felt that doctors had not adequately addressed the cause of the itch. Among patients who reported itch, the DLQI score correlates with the severity of pruritus with a regression coefficient of 0.2737 (P <0.001); 9.6% of patients with itch were independent with their activities of daily living compared to 21% of patients who did not experience itch.</p><p><b>CONCLUSION</b>Almost half of the subjects in our study experienced itch and a third of them reported impairment of quality of life. Patients who were independent of their activities of daily living were also less likely to experience itch. This study highlights the importance of increasing awareness of pruritus among physicians as pruritus can have adverse consequences on patients' quality of life when left unaddressed.</p>

Cutaneous Adverse Drug Reactions in a General Hospital in Singapore: A One-Year Retrospective Analysis

Background Rashes are the most common adverse reaction to drugs. Our aim is to describe (i) the prevalence of cutaneous adverse drug reactions in hospitalised patients over a 1-year period in our hospital; (ii) the variety of cutaneous drug reactions; (iii) the characteristics of patients with cutaneous drug reactions and (iv)the drugs implicated. Methods A retrospective analysis of all adverse drug reactions from the pharmacists’ database from January to December 2003 was conducted. Patients’ records were reviewed to extract demographic data, drug implicated, route of administration, drug allergy history, type of cutaneous reaction, severity and presence of underlying chronic disease. Results Sixty-five patients met our inclusion criteria, giving an estimated prevalence of 1.8/1000 among hospitalised patients. The cases were mostly from the general medicine department (64.6%), with a slight male predominance (males, 53.8%; females 46.2%). Cutaneous adverse drug reactions were more common in the Malay population (32.3%). The mean age was 41.6 years (range, 13 to 85 years). The main drugs implicated were antibiotics (49.2%), mainly penicillins and cephalosporins, and non-steroidal anti-inflammatory agents (16.9%). Urticarial (46.1%) and generalised maculopapular eruptions (40.0%) were the most common patterns encountered. Others included Stevens-Johnson syndrome/toxic epidermal necrolysis (7.7%), drug reaction with eosinophilia and systemic symptoms (1.5%) and erythroderma (1.5%). 29.2% of cases were considered to be severe. There were no deaths. 44.6% had an associated chronic disease and 24.6% had a previous documented drug allergy. Conclusion Antibiotics and NSAIDs were the major drugs involved. The commonest cutaneous manifestations were urticarial and maculopapular eruptions. A high proportion of reactions were considered severe and almost one-quarter had a previous drug allergy.