An epidemiological and clinical analysis of cutaneous adverse drug reactions seen in a tertiary hospital in Johor, Malaysia.

BACKGROUND: The prevalence, clinical patterns, and causative drugs of cutaneous adverse drug reactions (cADR) vary among the different populations previously studied. AIM: To determine the prevalence, the clinical patterns of drug eruptions, and the common drugs implicated, particularly in severe cADR such as Stevens-Johnson Syndrome/Toxic epidermal necrolysis (SJS/TEN) and drug rash with eosinophilia and systemic symptoms (DRESS) in our population. METHODS: We analyzed the database established for all cADR seen by the department of Dermatology from January 2001 till December 2010. RESULTS: A total of 362 cADR were seen among 42 170 new clinic attendees, yielding an incidence rate of 0.86%. The most common reaction pattern seen was maculopapular eruption (153 cases) followed by SJS/TEN (110 cases) and DRESS (34 cases). Antibiotics was the most commonly implicated drug group (146 cases) followed by anticonvulsants (81 cases) and antigout drugs (50 cases). The most frequently implicated drug was allopurinol (50 cases). Carbamazepine, allopurinol, and cotrimoxazole were the three main causative drugs of SJS/TEN accounting for 21.8%, 20.9%, and 12.7%, respectively, of the 110 cases seen, whereas DRESS was mainly caused by allopurinol (15 cases). Mortality rates for TEN, SJS, and DRESS were 28.6%, 2.2%, and 5.9%, respectively. CONCLUSIONS: The low rate of cADR with a high proportion of severe reactions observed in this study was probably due to referral bias. Otherwise, the reaction patterns and drugs causing cADR in our population were similar to those seen in other countries. Carbamazepine, allopurinol, and cotrimoxazole were the three main causative drugs of SJS/TEN in our population.

Severe cutaneous adverse reactions due to isoniazid in a HIV positive patient.

Severe Cutaneous Adverse Reaction (SCAR) represents the spectrum of adverse drug reactions from erythema multiforme, Stevens - Johnson syndrome (SJS) to Toxic Epidermal Necrolysis (TEN). A 55 year old lady presented in a toxic state with peeling of skin, blisters on the body of seven days duration following medications taken for fever and pulmonary tuberculosis. When referred to our institution, she was diagnosed as TEN. Immediately the suspected medications were stopped. The essential investigations were done including the screening for immunosuppression, which was found to be negative. The patient was treated symptomatically with emphasis on skilled nursing care. The patient's skin condition improved gradually but tuberculosis progressively worsened over three months. Thus patient was reinvestigated for seropositivity and was found to be positive. Considering the benefit - risk ratio along with the advice of the pulmonologist, a decision was made to give her a rechallenge test, first for antitubercular drugs and later for antipyretics. The patient developed SJS within two days of starting isoniazid (INH). On withdrawal of INH the patient recovered.