ABSTRACT
INTRODUCTION: Practically all physicians encounter a diverse range of suspected cutaneous adverse drug reactions (CADRs) in their daily clinical practice. The skin and mucosa are the most often encountered areas for the early presentation of numerous adverse drug reactions. Cutaneous adverse drug reactions are classified as benign or severe. The clinical manifestations of drug eruptions can range from mild maculopapular exanthema to severe cutaneous adverse drug reactions (SCARs). OBJECTIVE: To determine the varied clinical and morphological presentations of CADRs and to identify the culprit drug and common drugs causing CADRs. MATERIALS AND METHODS: Patients with clinical features suspected of CADRs presenting to the outpatient department (OPD) of dermatology, venereology, and leprosy (DVL) between December 2021 to November 2022 at Great Eastern Medical School and Hospital (GEMS), Srikakulam, Andhra Pradesh, India, were considered for the study. This was a cross-sectional, observational study. The patient's clinical history was taken in detail. This included chief complaints (symptoms, site of onset, duration, drug history, latency time between drug administration and the appearance of cutaneous lesions), family history, associated diseases, the morphology of lesions, and mucosal examination. Upon drug discontinuation, improvement in cutaneous lesions and systemic features were noted. A complete general examination, systemic examination, dermatological tests, and mucosal examination were performed. RESULTS: A total of 102 patients were involved in the study, of whom 55 were males and 47 were females. The male-to-female ratio was 1.17:1, with a slight male majority. The most common age group was 31 to 40 years for both males and females. Itching was the predominant complaint in 56 patients (54.9%). The mean latency period was shortest in urticaria (2.13+/- 0.99 hours) and longest in lichenoid drug eruption (4.33+/- 3.93 months). Most patients developed symptoms after a week of taking the drug (53.92%). A history of similar complaints was present in 38.23% of patients. Analgesics and antipyretics (39.2%) were the most common culprit drugs followed by antimicrobials (29.4%). Among analgesics and antipyretics, aceclofenac (24.5%) was the commonest culprit drug. Benign CADRs were observed in 89 patients (87.25%), and severe cutaneous adverse reactions (SCARs) were observed in 13 patients (12.74%). The common CADRs presented were drug-induced exanthem (27.4%). Imatinib-induced psoriasis vulgaris and lithium-induced scalp psoriasis were observed in one patient each. Severe cutaneous adverse reactions were observed in 13 patients (12.74%). Anticonvulsants, nonsteroidal anti-inflammatory drugs (NSAIDs), and antimicrobials were the culprit drugs for SCARs. Eosinophilia was present in three patients, deranged liver enzymes was present in nine patients, a deranged renal profile was present in seven patients, and death occurred in one patient with toxic epidermal necrolysis (TEN) of SCARs. CONCLUSION: Before prescribing any drug to a patient, a detailed drug history and family history of drug reactions need to be obtained. Patients should be advised to avoid over-the-counter usage of medications and self-administration of drugs. If adverse drug reactions occur, it is advised to avoid readministration of the culprit drug. Drug cards must be prepared and given to the patient, mentioning the culprit drug as well as the cross-reacting drugs.
ABSTRACT
Introduction Hyperkeratotic lesions on the palms and soles are one of the most frequent clinical presentations encountered in dermatological practice, with a myriad of underlying etiologies that closely resemble one another and are clinically indistinguishable. Histopathological examination is the tool used by dermatologists to arrive at a final diagnosis, but it is invasive and not feasible under all circumstances. Dermoscopy is a new age, increasingly popular, noninvasive diagnostic technique of great value that is used to diagnose underlying etiology by acting as a bridge between clinical and histopathological pictures. This study aimed to evaluate the various etiologies underlying palmoplantar hyperkeratosis and the role of dermoscopy in the diagnosis of each disease along with its ability to delineate a close differential diagnosis and ensure appropriate treatment. Materials and methods This was a hospital-based observational cross-sectional study conducted from July 1 to December 31, 2022. Consenting patients with hyperkeratotic palmoplantar lesions on clinical examination attending the dermatology outpatient department at our tertiary care hospital were included after institutional ethical clearance was obtained. Patients with HIV, hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) infection, or a history of hyperkeratotic lesions since birth, i.e., inherited palmoplantar keratodermas, were excluded from the study. A total of 60 patients aged between 18 and 60 years who met the above criteria were included. A complete history was taken; a thorough examination was performed. Routine investigations and tissue histology were done. Potassium hydroxide (KOH) mount and patch testing were done as and when required. Dermoscopy with DermLite DL4 was performed in all cases on lesional areas, and the findings were noted. Results Palmoplantar psoriasis has been found to be the most common cause of hyperkeratosis in our study with 24 (40%) out of 60 cases, followed by chronic hand-foot eczema found in 19 (31%) cases. Dermoscopic findings that help in differentiating various etiologies are vascular findings and scaling types. Vascular findings, mainly regularly arranged dots and globules, were more prominent in palmoplantar psoriasis. Yellow white scaling was frequently observed in hyperkeratotic hand eczema. Most of the cases corresponded with their provisional diagnoses on histopathology, but four out of 19 histopathologically confirmed cases of eczema showed clinical resemblance to palmoplantar psoriasis, along with dermoscopic features of psoriasis. Two out of four cases of histopathologically confirmed palmoplantar LP were clinically considered palmoplantar psoriasis and hyperkeratotic hand-foot eczema. Conclusion Although hyperkeratoses of palms and soles are a common clinical entity, the similarity between the clinical features of the underlying conditions causes a diagnostic dilemma for treating dermatologists. Dermoscopy is a noninvasive, quick, reproducible, supportive investigation in the diagnosis of these conditions that certainly aids in reaching closer to a differential diagnosis and for better delineation, but it does not avert the need for a skin biopsy. Further confirmation with histopathological examination is advisable, especially in these conditions as they show close morphological similarity. A combination of all these investigations and clinical examinations gives better diagnoses and appropriate treatment.
