Browsing by Author "Bekhtari, Soumeya"

2% of drug induced cutaneous adverse reactions are severe and potentially life threatening. These include Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS) and erythema multiforme major (EM). The aim of this study was to assess severe cutaneous drug reactions. We searched for all cutaneous adverse drug reactions from hospital records at Department of dermatology and allergology, Helsinki University hospital, between 2007 and 2017. There were 338 patients altogether. Forty-one (12%) of them were diagnosed with SJS/TEN, EM, AGEP or DRESS. Age range in these reactions was 26 – 88 years (mean 58,1). 68% of patients were women. The most common culprit drugs were antibiotics, systemic antifungals, hydroxychloroquine, sulfasalazine, non-steroidal anti-inflammatory drugs and anticonvulsants. The time interval from the start of the culprit drug to the skin reaction could vary from a day to one year. Comorbidities and polypharmacy were common. A preceding infection was reported in 56% of cases. Systemic symptoms were present in 44% of patients. 54% of patients had mucous involvement. Most patients (93%) had elevated CRP levels. Blood eosinophilia was present in 46% of patients and elevated liver enzymes in 68% of patients. 10% of patients suffered from late complications. Laboratory tests are nonspecific to diagnosis of these reactions, but combined with an appropriate clinical presentation and histology in skin biopsy, they help in setting diagnosis. Drug rechallenge is rarely indicated because there are alternatives to the suspected offending drug to be able to treat most conditions. Rapid withdrawal of the culprit drug is the most important step in treatment of these drug reactions.