Cutaneous reactions to nonsteroidal anti-inflammatory drugs (original) (raw)

Dermatological adverse drug reactions due to systemic medications–a review of literature

Journal of Pakistan …, 2006

Cutaneous adverse drug reactions (ADRs) affect 2-3% of hospitalized patients. These reactions can arise as a result of immunologic or non-immunologic mechanisms. Extremes of age, female sex, previous history of ADRs and environmental factors are the major risk factors. The severity of the cutaneous ADRs may vary from a mild itching to a life threatening Stevens-Johnson syndrome (SJS). In general, most are usually mild and respond to topical treatment. Different skin diseases and cutaneous manifestation of systemic diseases should be ruled out before diagnosing a cutaneous ADR. In order to establish the causal relationship between the offending drug and the reaction, causality assessment should be carried out. The Naranjo algorithm is widely used to determine the causality of an ADR. The cessation of the offending agent, along with the use of systemic and topical steroids, antipruritic agents and oral antihistamines may be helpful in the management. Patients with extensive skin involvement should be cared for as burns patients. High risk patients should be counseled regarding the possibility of developing a cutaneous ADR during the course of treatment and the strategies to be followed upon occurrence of a cutaneous ADR.

Drug-induced skin reactions: a 2-year study

Clinical, Cosmetic and Investigational Dermatology, 2015

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Severe drug‐induced skin reactions: clinical pattern, diagnostics and therapy

JDDG: Journal der Deutschen …, 2009

Cutaneous drug eruptions are common, with a prevalence of approximately 2 % to 3 % in hospitalized patients.[Bigby, 2001, Bigby, et al., 1986] It has been estimated that 1 of every 1000 hospitalized patients has a serious cutaneous drug reaction.[Roujeau and Stern, 1994] In clinical practice, the diagnosis of a cutaneous drug eruption is based on a clinical history suggesting that the rash is temporally related to the consumption of a new drug, the gross morphology of the rash, and, often, the histopathologic examination of a skin biopsy. The diversity of cutaneous drug eruptions is broad.[Kaplan, 1984, Roujeau, 2005, Wintroub and Stern, 1985] The vast majority of drug reactions is represented by morbilliform (scarlatiniform or rubeoliform) exanthemas (40%).[Gerson, et al., 2008] Followed by urticaria and angioedema, they account for up to 95% of cutaneous reactions.[Crowson, et al., 2003, Kauppinen and Stubb, 1984, Stubb, et al., 1994] Although generalized and often developing fast with some systemic symptoms such as pruritus, burning or shiver, these drug reactions are not severe and usually stop rapidly without much intervention after cessation of the culprit drug. Histopathologically, drug reactions may simulate each of the patterns of inflammatory diseases of the skin and subcutaneous fat. However, by far the most common pattern evoked by them is "interface dermatitis".[Ackerman, et al., 2005] That pattern usually is joined by an infiltrate that encircles only the venules of the superficial plexus, but, episodically, the infiltrate is present around venules of both vascular plexuses. Of the two types of interface dermatitis induced by drugs, namely, vacuolar and lichenoid, the vacuolar is the most common. Severe drug-induced skin reactions include Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), moreover, generalized bullous fixed drug eruption (GBFDE), acute generalized exanthematous pustulosis (AGEP), and drug reaction with eosinophilia and systemic symptoms (DRESS). Furthermore, toxic erythemas after chemotherapy and drug-induced linear-IgA-dermatosis should be listed among them. Within the following chapter they will be elucidated from a clinical but in particular histopathologic point of view. www.intechopen.com Skin Biopsy-Perspectives 88 2. Stevens-Johnson syndrome and toxic epidermal necrolysis 2.1 Clinical presentation SJS and TEN are viewed as a single disease entity of different severity.[Bastuji-Garin, et al., 1993] Both are characterized by a macular confluent erythema evolving into sometimes extensive blistering or epidermolysis that resembles a second degree burn (figures 1A and 2A). This is accompanied by mucosal erosions, especially affecting the mouth, the lips, the (a)

An observational study of drug induced cutaneous reactions used in various group of patients

2016

Adverse drug reactions (ADRs) are noxious and unintended response to medicines. The detection and evaluation of ADRs of new drug is often delayed because they have long latency and are unexpected. But now a days pharmacovigilance surveillance system makes it possible for physicians, pharmacist and other health care providers to report suspected ADRs. The objective of this prospective study was to assess clinical pattern of drug induced cutaneous reactions in Dermatology OPD. In our study total of 60 patients with suspected cutaneous adverse drug reactions were recruited. A detailed physical examination was done by a physician including drug intake during 3 weeks preceding reactions and type of drug reactions. Most frequently reported cutaneous drug reactions were Stevens Johnson Syndrome (23%), Maculopapular rash (18%) Toxic Epidermal Necrolysis (15%) and were caused by antiepileptic drugs in 21(35%) patients, followed by antibiotics in 17(28.33%) cases, NSAID’s in 7(11.6%) cases, a...

Adverse cutaneous drug reactions: Eight year assessment in hospitalized patients

Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 2014

Adverse cutaneous drug reactions (ACDRs) are the most commonly reported adverse drug events. The causative drugs and clinical patterns of ACDRs are different in various populations. This study was conducted to identify the clinical patterns, causative drugs and reasons for drug administration in patients hospitalized due to ACDR. This retrospective study was carried out in a referral university hospital, Isfahan, Iran. The medical records of all patients who were hospitalized in the Dermatology Department due to ACDRs were reviewed covering an 8-year period between December 2006 and August 2013. A total number of 282 patients with the mean age of 29.48 ± 21.18 years were hospitalized in this time period, of which 61% were females. The most common clinical patterns regarding the final diagnosis were Stevens-Johnson syndrome (SJS) (32%), exanthematous drug eruptions (24.5%) and toxic epidermal necrolysis (TEN) (11%). Anticonvulsants were the most frequently implicated drug group (51.8...

Clinico-Epidemiological Study of Cutaneous Adverse Drug Reactions: A Hospital-Based Study

Journal of Evidence Based Medicine and Healthcare

BACKGROUND Cutaneous drug reactions are the most common adverse reactions attributed to drugs. They often mimic or cause common cutaneous reaction patterns such as bullous disorders, lichen planus, psoriasis, eczema etc., METHODS It was a hospital based cross sectional study including 140 clinically diagnosed cases of Cutaneous Adverse Drug Reaction (CADR). Demographic details, clinical patterns, types of drugs and causality assessment were studied in each one of them. RESULTS Most common age group to have CADR was 21-40 years. The male to female ratio was 2.25:1. Fixed Drug Eruption including the bullous variant was the commonest, seen in 45.71% patients and followed by maculopapular rash in 17.14% and Stevens Johnson Syndrome (SJS) in 11.42%. The commonest offending group of drug as a whole was Antimicrobials (54.3%) followed by Non-Steroidal Anti Inflammatory Drugs (NSAID) (37.85%) and Antiepileptics (5.71%). CONCLUSIONS CADR commonly presents as Fixed Drug Eruption or maculopapular lesions and commonly implicated drugs are Antimicrobials, NSAIDs and Anti-Epileptics.

Patterns of Cutaneous Drug Reactions: A Review

SBV Journal of Basic, Clinical and Applied Health Science, 2019

Introduction: A cutaneous adverse drug reaction (CADR) is defined as any undesirable cutaneous clinical manifestation resulting from administration of a particular drug. The CADRs are a common problem in our country and can range from simple rash to severe reactions. Early recognition of CADRs enables early identification and withdrawal of offending drugs, thereby reducing morbidity and mortality. This article is a review of the patterns of presentation of CADR and common causative drugs in our country. Materials and methods: Literature search was performed across PubMed Central and Google Scholar search engine using key words like adverse cutaneous drug reaction, adverse cutaneous drug reaction, India, and articles selected. Results: The most common drug groups causing CADR in our country are antimicrobials, anticonvulsants and nonsteroidal anti-inflammatory drugs (NSAIDs), and antigout agents. Common presentations of CADR are in the form of exanthematous skin eruptions, urticaria, fixed drug eruption (FDE), contact dermatitis, angioedema, Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN), and various morphologic permutations and combinations. Conclusion: A CADR is a common problem and an economic burden to our healthcare. The presentation of CADR and the drugs causing CADR have a geographic variation in our country. Understanding common causative drugs, the presentation of CADR can help in early diagnosis, identification, and withdrawal of the culprit drug resulting in early recovery and preventing complications of CADR.

Severe cutaneous adverse drug reactions

Medical Journal Armed Forces India, 2013

Toxic epidermal necrolysis Erythroderma DRESS Vasculitis a b s t r a c t Severe cutaneous drug reactions are one of the commonest medical challenges presenting to an emergency room in any hospital. The manifestations range from maculopapular rash to severe systemic symptoms like renal failure and cardiovascular compromise. Toxic epidermal necrolysis, erythroderma, drug rash with eosinophilia and systemic symptoms, acute generalised exanthematous pustulosis and drug induced vasculitis are the common cutaneous drug reactions which can have severe morbidity and even mortality. Careful history taking of the lag period after drug intake and associated symptoms, along with detailed examination of the skin, mucosa and various systems, help in early diagnosis of these reactions. Early stoppage of the incriminating drug, specific therapy including corticosteroids, cyclosporine and intravenous immunoglobulin depending on the case along with supportive therapy and local measures help in salvaging most patients. An overview of these important cutaneous drug reactions along with their management is being reviewed in this article. ª /locate/mjafi m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 6 9 ( 2 0 1 3 ) 3 7 5 e3 8 3

cutaneous adverse drug reactions-re l e v a n t aspects to diagnosis and treatment-Part II *

2004

Severe cutaneous adverse drug reactions generally require hospitalization, sometimes in intensive care or burns units, for observation of the vital signs and the visceral function. The objective was to describe these reac tions in order to facilitate recognition and treatment. This group of drug reactions includes drug hypersensitivity syndrome (DHS), acute generalized exanthematous pustulosis (AGEP), anticoagulant-induced skin necrosis, smallvessel vasculitis (SVV), propylthiouracil hypersensitivity vasculitis and serum sickness disease. DHS has been most relevant due to universal prescription of aromatic anticonvulsant drugs and dapsone use in the treatment of some diseases such as acne and leprosy. AGEP is mostly induced by b-lactam related drugs and presents similar clinical characteristics as generalized pustular psoriasis, thus these must be differentiated. SVV can present an occult sys temic illness, with impairment of relevant internal organs, such as kidneys, lungs and hema...