Severe cutaneous adverse drug reactions: Stevens Johnson Syndrome and toxic epidermal necrolysisa, a report of 4 cases seen at UMMC

Prescribing medication is not without its adverse effects. Complications due to drug therapy are on the rise in Malaysia, especially when antibiotics are used indiscriminately. We reviewed cases admitted to the Acute Medical Ward of University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia, over a two-month period from March to April 2009. The authors found that Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) were the most common severe adverse cutaneous reactions due to ingestion or parenteral use of drugs. In this report, is a brief description of the two conditions and ways to manage them. The authors have come to a conclusion that judicious use of medications with adequate patient education is important in order to avoid these adverse effects

Incidence and risk factors for cutaneous adverse drug reactions in an intensive care unit / Incidencia y factores de riesgo en las reacciones adversas medicamentosas de tipo cutáneo en la unidad de cuidados intensivos

Objective. To evaluate the incidence of adverse cutaneous drug reactions in intensive care unit patients. Design. Cohort study. Setting. General adult intensive care unit of an institutional tertiary care hospital. Patients. Patients in the intensive care unit during a consecutive 8-month period were examined for adverse cutaneous drug reactions. Results. Patients in the intensive care unit have an incidence of 11.6% of adverse cutaneous drug reactions. Associated risk factors were female gender, obesity, age over 60 and immune dysregulation (systemic lupus erythematosus, dysthyroidism, and antiphospholipid antibodies syndrome). Few patients had previous history of adverse cutaneous drug reactions. Antimicrobials were the main drug involved. Morbilliform rash followed by urticary were the most frequently observed reactions. Interestingly, over 50% of patients with massive edema -independent of etiology- died. Conclusions. Intensive care unit patients are particularly at risk for developing an adverse cutaneous drug reaction.

Se realizó un estudio de cohorte en la Unidad de Terapia Intensiva (UTI) de un hospital de tercer nivel para evaluar la incidencia de reacciones cutáneas adversas a drogas. Se examinaron todos los pacientes internados en dicha unidad durante un periodo consecutivo de ocho meses. Observamos una incidencia de reacciones adversas a medicamentos de 11.6%. Los factores de riesgo asociados fueron sexo femenino, obesidad, edad mayor a 60 años y alteraciones inmu-nológicas (lupus eritematoso sistémico, distiroidismo y síndrome de antifosfolípido). Los antimicrobianos fueron los principales medicamentos involucrados. La erupción morbiliforme y la urticaria fueron las reacciones más frecuentes. Un hallazgo interesante fue que más de 50% de los pacientes con anasarca fallecieron. Concluimos que los pacientes internados en la UTI son particularmente susceptibles para desarrollar una reacción adversa cutánea a medicamentos.

Cutaneous drug reactions and their causative agents as seen at the Philippine General Hospital Section of Dermatology from January 2001 to March 2003

BACKGROUND: As much as 90% of adverse drug reactions (ADR) present with cutaneous manifestations. Epidemiologic data on reported ADR from all over the world are being used to predict which drugs may produce a reaction and to identify risk factors in the population. This study is the first such endeavor in the PGH Section of DermatologyStudy Objective: To gather and present data on the incidence rate, demographic characteristics, and clinical spectrum of dermatologic consults of drug reactions; to list the identity and classes of the drugs involved; to compare gathered data with trends seen in world literatureStudy Design: Retrospective studyParticipants: Cases of cutaneous drug reactions seen by the Section of Dermatology as out patients or as referrals from the wards, for the period January 2001 to March 2003. Acneiform drug eruptions and coumadin necrosis were not included in the studyOutcome Measures and Analysis: Incidence rates of cutaneous drug reactions for the past two years were computed. Epidemiologic data and the clinical profile of drug reactions, as well as the causative drugs were tabulated; frequencies were takenResults: Of the 188 suspected cases of drug reactions, 155 (82%) charts were retrieved. Of these, 119 cases were confirmed to be drug reactions and included in the study. Incidence rates for the years 2001 and 2002 were 4.2 and 5 per 1000 new consults, respectively. The age of the patients ranged from 1 month to 81 years old. Majority (72%) was in the adult age group (19-64 years old). The male to female ratio was fairly equal at 1:1.4. Diagnosis was confirmed by biopsy in 44% of the cases. The top 3 clinical presentations of cutaneous drug reactions were: morbilliform rash, fixed drug eruption, and urticaria. Other cutaneous lesions included erythroderma/exfoliative dermatitis, vessiculobullous lesions, erythema multiforme, lichenoid eruptions, vasculitis, photoallergy, Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). The most common causes of drug reactions were antibiotics (Cotrimoxazole, Amoxicillin), NSAIDs and anti-Kochs drugs. Antibiotics were responsible for 42% of cutaneous drug reactions and 41.9% of morbilliform rashes. Cotrimoxazole was the culprit drug in 40.7% of FDE. Anticonvulsants were responsible for half of the cases of life-threatening SJS and TENConclusions: There is no sex predilection for ADR. Various clinical manifestations of cutaneous drug reactions are seen at the PGH Section of Dermatology. They are caused by varied drugs, of which the most common causes are antibiotics (Cotrimoxazole, Amoxicillin), NSAIDs and anti-Kochs. The clinical pattern and drugs causing cutaneous drug reactions are similar to those observed in other countries, with minor variations.