BACKGROUND: As much as 90% of adverse drug reactions (ADR) present with cutaneous manifestations. Epidemiologic data on reported ADR from all over the world are being used to predict which drugs may produce a reaction and to identify risk factors in the population. This study is the first such endeavor in the PGH Section of Dermatology
Study Objective: To gather and present data on the incidence rate, demographic characteristics, and clinical spectrum of dermatologic consults of drug reactions; to list the identity and classes of the drugs involved; to compare gathered data with trends seen in world literature
Study Design: Retrospective study
Participants: Cases of cutaneous drug reactions seen by the Section of Dermatology as out patients or as referrals from the wards, for the period January 2001 to March 2003. Acneiform drug eruptions and coumadin necrosis were not included in the study
Outcome Measures and Analysis: Incidence rates of cutaneous drug reactions for the past two years were computed. Epidemiologic data and the clinical profile of drug reactions, as well as the causative drugs were tabulated; frequencies were taken
Results: Of the 188 suspected cases of drug reactions, 155 (82%) charts were retrieved. Of these, 119 cases were confirmed to be drug reactions and included in the study. Incidence rates for the years 2001 and 2002 were 4.2 and 5 per 1000 new consults, respectively. The age of the patients ranged from 1 month to 81 years old. Majority (72%) was in the adult age group (19-64 years old). The male to female ratio was fairly equal at 1:1.4. Diagnosis was confirmed by biopsy in 44% of the cases. The top 3 clinical presentations of cutaneous drug reactions were: morbilliform rash, fixed drug eruption, and urticaria. Other cutaneous lesions included erythroderma/exfoliative dermatitis, vessiculobullous lesions, erythema multiforme, lichenoid eruptions, vasculitis, photoallergy, Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). The most common causes of drug reactions were antibiotics (Cotrimoxazole, Amoxicillin), NSAIDs and anti-Kochs drugs. Antibiotics were responsible for 42% of cutaneous drug reactions and 41.9% of morbilliform rashes. Cotrimoxazole was the culprit drug in 40.7% of FDE. Anticonvulsants were responsible for half of the cases of life-threatening SJS and TEN
Conclusions: There is no sex predilection for ADR. Various clinical manifestations of cutaneous drug reactions are seen at the PGH Section of Dermatology. They are caused by varied drugs, of which the most common causes are antibiotics (Cotrimoxazole, Amoxicillin), NSAIDs and anti-Kochs. The clinical pattern and drugs causing cutaneous drug reactions are similar to those observed in other countries, with minor variations.