Gynecomastia is swelling of the breast tissue in men, caused by an imbalance of the hormones, estrogen and testosterone. Drugs commonly implicated are spironolactone, cimetidine, ketoconazole, hGH, estrogens, hCG, anti-androgens, GnRH analogues and 5-α reductase inhibitors. Medications probably associated with gynecomastia include risperidone, verapamil, nifedipine, omeprazole, alkylating agents, HIV medications (efavirenz), anabolic steroids, alcohol and opioids. HIV infected patients who are treated with highly active antiretroviral therapy (HAART) can develop breast enlargement due to benign and malignant mammary diseases. We report here a case of gynecomastia due to efavirinz.

Background: Incidence of cutaneous adverse drug reactions (CADRs) in developed countries is 1 to 3% and in developing countries, it is much higher i.e. 2 to 6%. 1 in 1000 hospitalized patients will develop severe cutaneous adverse reaction. Maculopapular rash represents majority of cutaneous drug reaction followed by urticaria. Most frequently elicited CADRs are associated with antimicrobials and NSAIDs. This study was designed to monitor Cutaneous adverse drug reaction profile of tertiary care teaching hospital.Methods: This is a prospective observational study of 6 months’ duration to monitor cutaneous adverse drug reactions in dermatology department of tertiary care teaching hospital. CADRs were analysed with respect to demographic details, suspected drugs and type of reaction. Causality assessment is by Naranjo algorithm. Data is represented in tables and graphs. Data is analyzed in Microsoft excel 2007.Results: Total 57 cases of cutaneous adverse drug reactions were reported. Among them, 57.9% were in males and 42.1% were in females. Majority of CADRs were due to antiretroviral drugs (38.5%) followed by antibacterial (28%) and antiepileptics (14%). Maculopapular rash is most common CADR (35%). Causality of 74% CADRs were probable according to Naranjo algorithm.Conclusions: CADRs are more commonly associated with antiretroviral therapy (ART), antibacterial drugs and antiepileptic drugs. In case of ART, antiepileptic drug and drugs used in chronic illness compliance plays a major role in the success of therapy. Adverse drug reactions lead to problem of non compliance and failure of therapy. Cutaneous adverse reactions like FDE heal with hyper pigmentation leads to cosmetic problem. Stevens Johnson syndrome (SJS) is life threatening that requires prompt withdrawal of drug and intensive medical management. Many drugs are available without prescription in India leading to problem of misdiagnosis of CADRs. So, data obtained from this study helps in proper diagnosis and treatment of CADRs.

Stevens-Johnsons syndrome and toxic epidermal necrolysis are the most severe cutaneous adverse reactions to medications. These are characterized by the detachment of dead epidermis and the erosion of mucus membrane. Lamotrigine is an antiepileptic drug used in the management of various forms of seizures. Lamotrigine is also useful in preventing the depressive phase of manic depressive disorder. We present a case of toxic epidermal necrolysis induced by Lamotrigine to increase the awareness to this life threatening adverse drug reaction to Lamotrigine, as Steven Johnson syndrome and Toxic epidermal necrolysis have a significant impact on public health in view of their high mortality and morbidity.