Acute Disease ; Antimetabolites, Antineoplastic ; adverse effects ; toxicity ; Drug-Related Side Effects and Adverse Reactions ; Female ; Folic Acid Antagonists ; therapeutic use ; Humans ; Methotrexate ; adverse effects ; toxicity ; Middle Aged ; Nausea ; chemically induced ; Risk Factors ; Skin Diseases ; chemically induced ; Vomiting ; chemically induced

Aged ; Bone Density Conservation Agents ; adverse effects ; Female ; Humans ; Organometallic Compounds ; adverse effects ; Osteoporosis, Postmenopausal ; drug therapy ; Stevens-Johnson Syndrome ; chemically induced ; diagnosis ; physiopathology ; Thiophenes ; adverse effects

Background Rashes are the most common adverse reaction to drugs. Our aim is to describe (i) the prevalence of cutaneous adverse drug reactions in hospitalised patients over a 1-year period in our hospital; (ii) the variety of cutaneous drug reactions; (iii) the characteristics of patients with cutaneous drug reactions and (iv)the drugs implicated. Methods A retrospective analysis of all adverse drug reactions from the pharmacists’ database from January to December 2003 was conducted. Patients’ records were reviewed to extract demographic data, drug implicated, route of administration, drug allergy history, type of cutaneous reaction, severity and presence of underlying chronic disease. Results Sixty-five patients met our inclusion criteria, giving an estimated prevalence of 1.8/1000 among hospitalised patients. The cases were mostly from the general medicine department (64.6%), with a slight male predominance (males, 53.8%; females 46.2%). Cutaneous adverse drug reactions were more common in the Malay population (32.3%). The mean age was 41.6 years (range, 13 to 85 years). The main drugs implicated were antibiotics (49.2%), mainly penicillins and cephalosporins, and non-steroidal anti-inflammatory agents (16.9%). Urticarial (46.1%) and generalised maculopapular eruptions (40.0%) were the most common patterns encountered. Others included Stevens-Johnson syndrome/toxic epidermal necrolysis (7.7%), drug reaction with eosinophilia and systemic symptoms (1.5%) and erythroderma (1.5%). 29.2% of cases were considered to be severe. There were no deaths. 44.6% had an associated chronic disease and 24.6% had a previous documented drug allergy. Conclusion Antibiotics and NSAIDs were the major drugs involved. The commonest cutaneous manifestations were urticarial and maculopapular eruptions. A high proportion of reactions were considered severe and almost one-quarter had a previous drug allergy.

Aged ; Diagnosis, Differential ; Exanthema/etiology* ; Female ; Humans

Adult ; Cardiomyopathies ; diagnosis ; etiology ; Electrocardiography ; Heart Block ; diagnosis ; etiology ; Humans ; Male ; Sarcoidosis ; complications ; diagnosis ; pathology ; Skin Diseases ; diagnosis ; etiology ; pathology

INTRODUCTIONInflammatory tinea capitis is an uncommon condition in Singapore. In this case report we present a patient whom we managed for this condition.

CLINICAL PICTUREA 4-year-old girl presented to us with multiple pustules over the occipital scalp for 6 weeks, associated with painful cervical lymphadenopathy. Her condition did not respond to topical and oral antibiotics.

TREATMENTThe patient was diagnosed with kerion (inflammatory tinea capitis) and fungal culture of plucked hairs from the kerion grew Microsporum species of dermatophyte. She was treated with a course of oral griseofulvin and topical selenium sulfide shampoo. She was advised to bring her pet cats to the veterinarian for screening, as well as not to share combs with her other siblings.

OUTCOMEHer condition improved with the antifungal therapy, and there was no residual alopecia.

CONCLUSIONPhysicians should consider tinea capitis when they encounter a patient with scalp folliculitis or scarring alopecia in the appropriate clinical context.

Administration, Oral ; Administration, Topical ; Antifungal Agents ; administration & dosage ; Child, Preschool ; Female ; Griseofulvin ; administration & dosage ; Humans ; Microsporum ; isolation & purification ; Selenium Compounds ; administration & dosage ; Tinea Capitis ; drug therapy ; microbiology

Aged, 80 and over ; Disseminated Intravascular Coagulation ; complications ; Forehead ; physiopathology ; Hemangioma, Capillary ; complications ; Hemangiosarcoma ; etiology ; physiopathology ; Humans ; Kasabach-Merritt Syndrome ; Male ; Scalp ; physiopathology

Humans ; Male ; Middle Aged ; Prurigo ; complications ; diagnosis ; Pruritus ; Sciatica

Aged ; Humans ; Keratoderma, Palmoplantar ; pathology ; Male ; Skin ; pathology