RESUMO
Background: The term severe cutaneous adverse reactions to drugs (SCAR) comprises of acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms complex (DRESS), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS-TEN) and drug-induced erythroderma or exfoliative dermatitis (ED). The present study aims at describing the epidemiological and clinical profile, probable cause and the extent of morbidity and mortality in patients with severe cutaneous adverse drug reactions. Methods: An observational study of all cases of SCAR presenting to our centre during the period from Jun 2018 to July 2019 was carried out. Results: A total of 24 SCAR patients were studied. Most of the patients were in the age group of 11-20 years. The commonest reactions observed were SJS-TEN (54.2%) followed by DRESS (42%). Antibiotics are the most common cause of SJS-TEN, whereas almost all the drug groups were implicated equally in DRESS. No causative drug could be found in two of the SJS-TEN patients. These patients had raised atypical targetoid lesions as well as evidence of viral reactivation which could have been the probable trigger for the SCAR. A total of five patients (20.8%) died during treatment in hospital, and the percentage mortality was highest in SJS-TEN. Conclusion: Nondrug aetiologies for SJS-TEN are on the rise, and this was observed in this study too. Viral reactivation may be the commonest aetiology in such cases, and the morphology of the rash can give a clue to such cases.
RESUMO
Background: Vitiligo is a depigmenting skin disorder resulting from the loss of melanocytes in the epidermis. Surgical treatment is indicated in resistant stable vitiligo that does not show adequate response to medical therapy. This study aims at comparing the efficacy of repigmentation by split-thickness skin grafting (STSG) versus autologous non-cultured melanocyte transfer (AMT) in the management of stable vitiligo. Methods: A total of 22 patients were recruited, which included 100 stable vitiligo patches. Fifty patches were subjected to STSG, and the remaining 50 were subjected to AMT. The patients were followed up at monthly intervals for six months to assess the degree of repigmentation. Results: The results at the end of six months were as follows: 40% patches in group A and 42.5% in group B exhibited >75% repigmentation. The outcome was better over the limbs, acral parts and joints. The average donor-to-recipient area ratio for group A was 1:1, whereas that for group B was 1:3.2. Conclusion: Both STSG and AMT are effective surgical modalities in the management of stable vitiligo. However, AMT has cosmetically better good outcomes, requires a smaller size of the donor area and has minimal complications over both recipient and donor areas.
