Adverse cutaneous drug reactions: clinical pattern and causative agents in a care center in central Egypt

ABSTRACT

Adverse cutaneous drug reactions [ACDRs] are caused by a wide variety of agents. Many of the commonly used drugs have reaction rates above one percent. There is a wide spectrum of cutaneous adverse drug reactions [ADR] ranging from a transient maculopapular rash to fatal toxic epidermal necrolysis [TEN]. The pattern of cutaneous ADR and the drugs responsible for them is changing every year. In this study, we present the data on clinical spectrum of various cutaneous ADR patterns and the causative drugs. To ascertain the clinical spectrum of ACDRs and the causative drugs in this part of Egypt and to find any risk factors. Case series study. National Hepatology and Tropical Medicine Research Institute [NHTMRI]. Out of the 6146 patients, ninety patients with adverse cutaneous drug reactions were enrolled in the study. Hematological and biochemical investigations were done in all of them. Patch testing and intradermal testing were done wherever feasible. The prevalence rate of adverse cutaneous drug reactions [ACDRs] among skin patients in this study was 1.46% [90/6146]. The mean age of the patients with cutaneous drug eruptions was 30.156 years [range, 4 month -75 year]. The male to female ratio was 0.875 1. The most common eruptions observed were urticaria 26 [28.9%] and fixed drug eruption [FDE] 22 [24.44%]. The drugs most often incriminated for the various cutaneous ADR were antimicrobials [53.3%] and NSAIDs [17.78%]. Sulfonamides accounted for 54.54% and NSAIDs for 27.27% of FDE. Urticaria was caused mainly by Cefadroxil [23.1%] and Penicillins [23.1%]. The mortality rate was 2. 2%. Most drug eruptions are benign, but a small percentage can be life threatening, including angioedema, vasculitis, Stevens-Johnson syndrome [SJS], toxic epidermal necrolysis [TEN], and anticoagulant necrosis. Therefore, prompt diagnosis and treatment as well as future avoidance of the medication are essential to reduce morbidity and mortality. If a medication is necessary, careful monitoring for severe reactions is important. The main caveat is that any medication has the potential to produce an adverse reaction, and any reaction has the potential to be life threatening. The clinical pattern and drugs causing cutaneous ADR are similar to those observed in other countries except for minor variations. Cutaneous ADR patterns and the drugs causing various reactions are changing every year, which may be due to the emergence of newer molecules and changing trends in the use of drugs