Acute localized exanthematous pustulosis: A novel side effect of piroxicam

Acute generalized exanthematous pustulosis (AGEP) is a rare yet well-known cutaneous reaction pattern, mostly caused by drugs. Acute localized exanthematous pustulosis (ALEP) is a localized variant of AGEP. A 42-year-old female presented with multiple erythematous pustules on the face, which appeared three days after the intramuscular injection of piroxicam. Histopathology revealed subcorneal pustules, epidermal spongiosis, and mixed inflammatory cell infiltration in the dermis. The pustules resolved within several days once the patient had discontinued the drug. Herein, we report the first case, as far as we know, of a female with a cutaneous drug reaction consistent with ALEP caused by piroxicam.

A Five-Year Review of Adverse Cutaneous Drug Reaction in a Tertiary Care Hospital in Yogyakarta, Indonesia

Background: The prevalence of adverse drug reactions is likely to increase, and it is associated with increased usage of various drugs. Adverse Cutaneous Drug Reaction (ACDR) is the most frequent adverse drug reaction (30–45%). In Indonesia, the study on the prevalence of ACDR is still limited. Purpose: This study investigated the prevalence, clinical features, causative agents, and mortality rate of ACDR with a type-IV hypersensitivity reaction among patients attending the Department of Dermatology and Venereology in Dr. Sardjito Hospital, Yogyakarta. Methods: This retrospective study was conducted examining medical records undertaken for five years (2011–2015). Of 68,375 patients medicated in the Department of Dermatology and Venereology, 397 patients were diagnosed as ACDR with a type-IV hypersensitivity reaction. Detailed history, including age, sex, past history, and family history of drug reaction taken by the patient, were obtained. Patch testing was done wherever feasible. Result: Of 68,375 patients, 397 patients were included in ACDR with type-IV hypersensitivity (0.58%), giving a 5% of mortality rate. The mean age of the patients was 40.42 years (±16.30; range 18 to 89 years). The female to male ratio was 1.1: 1. The Maculopapular rash was the most common ACDR manifestation (50.88%), followed by Stevens-Johnson Syndrome (13.85%), Fixed Drug Eruption (12.85%), and Drug Reaction with Eosinophilia and Systemic Symptoms (10.08%). The most common causative agents were beta-lactam (16.55%), NSAIDs (12.18%), and acetaminophen (8.62%). Conclusion: Prescription of those drugs should be considered carefully so the incidence of ACDR can be reduced.

Cutaneous Drug Reactions in Children Attending a Tertiary Care Hospital

Background: Cutaneous drug reaction (CDR) is a growing health hazard in the world. Adverse drug reactions are common complications in drug therapy. About 3-8% of all hospital admissions are the results of adverse drug reactions, among them 2-3% are children and these can cause significant disability to patients. Early identification and management of adverse cutaneous drug reaction has both short term and long term prognostic significance. Objective: To know the cutaneous reaction to drugs in children in a tertiary care hospital. Study design: Hospital based descriptive, observational study. Subjects: 50 children with cutaneous drug reactions were studied in the department of Dermatology and Pediatric respectively in Rajshahi Medical College Hospital, Rajshahi. Methods: Data were collected by detailed history taking, physical examination and laboratory investigations in a prefixed data collection sheet and with the help of GOLD guideline after taken informed consent of the patient. Results: This study showed a significant male predominance. Male: female ratio was 1.08:1 .In this study prevalence was highest among 1-5 years age group. Cotrimoxazole, NSAIDs, anticonvulsant and quinolone were most offending medications. Maculopapular eruption, Stevens Johnson Syndrome, fixed drug eruption and urticaria were most common morphological types. Majority of CDRs were noted with oral route of administration. It was observed that almost all the CDRs that were reported involved mainly the skin. Majority of adverse cutaneous drug reactions reported were moderate in severity. Conclusion: Frequency distribution of the offending drugs and the adverse reactions revealed that adverse cutaneous drug reactions occurred mostly by cotrimoxazole, NSAIDs and quinolones. Maculopapular rash and Stevens Johnson Syndrome were the most common morphological types. A better understanding of the mechanisms underlying CRDs is important in drug development and in patient care. TAJ 2020; 33(2): 56-62

Eczema herpeticum: A clinical diagnosis not to be missed

Eczema herpeticum is an uncommon complication of atopic dermatitis, but often has a typical recognisable appearance. This report serves to highlight this feature in a patient who was misdiagnosed initially with a bacterial skin infection and then with a severe cutaneous drug reaction.

Adverse cutaneous drug reactions reporting in a tertiary care teaching hospital in Eastern India: a retrospective study

Background: Any unwanted changes to mucous membrane, skin, its appendages and drug eruptions related adverse events are known as adverse cutaneous drug reaction (ACDR). It has 2-5% incidence in developing countries. The current study was undertaken to analyse adverse cutaneous drug reactions spectrum clinically, drugs responsible, assessment of causality, severity, and preventability in our setup.Methods: Current study was an observational, retrospective, non-interventional analysis of voluntarily reported ADRs forms, between April 2018 and January 2020. All cutaneous ADRs reported within this period were identified. Data obtained were expressed in numbers, percentages.Results: 130 cutaneous ADRs was reported during the period of study. Fixed drug eruptions (30%) was the most common cutaneous reaction. The most common causal drug groups were antimicrobials (58.5%). Amongst antimicrobials, ornidazole (8.5%) was the most common drug. The most common drug in NSAID group was paracetamol (14.6%). The major drug causing ACDRs in our study was Paracetamol (14.6%). Assessment of causality revealed 37.7% were probable and 62.3% were possible reactions. Assessment of severity showed 78.5% as mild and 21.5% as moderate. Assessment of preventability showed that 6.1% probably preventable and 93.9% not preventable.Conclusions: Knowledge of the pattern of cutaneous reactions and the causative drugs guides us in early diagnosis of the condition, better management and associated decrease in morbidity, mortality. In the current study, the most common causal drug group were antimicrobials. The most common morphological pattern and drug causing ACDRs were fixed drug eruptions and paracetamol, respectively.

A study of cutaneous morphological patterns of adverse drug reactions in tertiary care center, Chitradurga, Karnataka, India

<p class="abstract"><strong>Background:</strong> An adverse cutaneous drug reaction is an undesirable change in structure and function of skin, its appendages or mucous membrane due to drugs. The main aim of this study is to detect the pattern of adverse cutaneous drug reaction in a tertiary care hospital of Chitradurga district, Karnataka, India.</p><p class="abstract"><strong>Methods:</strong> A Hospital based cross sectional study was performed in a tertiary care hospital, Chitradurga for 6 months from January 2019 to June 2019. For each case, data regarding age, sex of the patient, clinical history, past history and comorbidities, name of suspected drugs, duration between drug intake and onset of reaction, morphology of drug eruption, associated mucosal or systemic involvement were analyzed.<strong></strong></p><p class="abstract"><strong>Results:</strong> During the 8 months study period, 30 patients have attended the dermatology outpatient department with cutaneous adverse drug reaction. Majority of the patients were in the age group 20-39 years and the male to female ratio was 1.1:1. The commonest drug reaction pattern observed was the maculopapular rash (40%), urticaria (20%), fixed drug eruption (5%), Stevens Johnson syndrome (10%), toxic epidermal necrolysis (6.7%) and exfoliative dermatitis (6.7%). Commonest drugs producing reactions were diclofenac (30%), amoxycillin (23.3%), carbamazepine (20%), anti-tubercular drugs (16.7%), phenytoin (6.7%) and dapsone (3.3%).</p><p class="abstract"><strong>Conclusions:</strong> Knowledge of the pattern and the offending drug helps in better management and reduced complications in these patients and also help in preventing recurrences.</p>