Reacciones adversas cutáneas a medicamentos: Vigilancia durante un año en un Hospital Universitario. Uruguay 2008-2009 / Adverse cutaneous reactions to Drugs among hospitalized patients: A one year surveillance

Background: Adverse cutaneous reactions to Drugs (CDRs) are of particular interest among all adverse Drug reactions (ADR) due to their frequency, potential severity and because of the importance of an early diagnosis. Antimicrobial agents, anticonvulsants and non-steroidal anti-inflammatory Drugs are the Drugs associated to the highest risk of CDRs. Aim: To assess CDRs in hospitalized patients and identify the Drugs involved. Material and Methods: All patients hospitalized in the Hospital de Clínicas in Montevideo, Uruguay, with suspected CDRs, detected during one year, were included in this prospective study. The imputability was established using the Karch and Lasagna algorithm modified by Naranjo. We analyzed age, gender, Drugs involved, causal disease, severity, latency and evolution. Results: Seventeen patients, aged 17 to 85 years (15 females) with CDRs were identifed. Twelve had morbilliform exanthemas, four had reactions with eosinophilia and systemic symptoms and one had a Stevens Johnson syndrome. The Drugs involved were antimicrobials in nine cases, hypouricemic agents in four cases, anticonvulsants in three cases and aspartic insulin in one. Twelve patients had a life threatening reaction and one required admission to the intensive care unit. No deaths occurred. Conclusions: CDRs were more common in women and most of them were caused by antimicrobial agents.

Clinical study of cutaneous drug eruptions in 200 patients.

BACKGROUND: Cutaneous drug reactions are the most common adverse reactions attributed to drugs. Any skin disorder can be imitated, induced or aggravated by drugs. AIMS: The present study was carried out to determine the age, sex incidence and clinical pattern of drug eruptions, to recognize offending drugs (self medication or prescribed), to evaluate mortality and morbidity associated with drugs, to educate the patients, and to avoid self-administration of drugs and re-administration of the offending drugs. METHODS: The diagnosis of cutaneous drug reactions is mainly based on detailed history and correlation between drug intake and the onset of rash. Two hundred patients (112 males and 88 females) presenting with cutaneous drug reactions were studied. RESULTS: Fixed drug eruption was seen in 61 patients; others being urticaria and angioedema, morbilliform rash in 37, pruritus in 25, Stevens Johnson (SJ) syndrome in six, purpura in six, exfoliative dermatitis in five, photosensitivity in five, Toxic Epidermal Necrolysis in two, acneiform eruption in three, and erythema multiforme in two patients. The most frequently affected age group was 41-50 years, followed by the 21-30 and 31-40 years age groups. The youngest patient was one year old and the oldest was 80 years old. The period of development of lesions after the intake of drug(s) varies from 01-45 days. Cotrimoxazole was the offending drug in 26 cases, followed by Ibuprofen in 20 cases. CONCLUSIONS: Fixed drug eruption was the most common drug eruption seen. Cotrimoxazole was the most common cause of drug eruptions.

Cutaneous drug reactions

Cutaneous drug reactions are among the most common causes of skin eruptions in hospitalized patients. In outpatient clinics, drug eruptions represent a diagnostic and therapeutic challenge to the physician as any drug can cause an adverse cutaneous reactions. These reactions may be mediated by immunologic or nonimmunologic mechanisms. Cutaneous drug reactions may manifest themselves in various clinical morphologic patterns. Factors such as sun-exposure, concomitant drugs or diseases and host immune status can influence the type and morphology of lesions. History taking is one of the most important aspects in the evaluation of these patients and must be oriented so as to provide the information that will lead to the final diagnosis