Severe Cutaneous Adverse Reactions to Drugs

Objective: This study was undertaken to identify the most common drug causing drug reaction with eosinophilia and systemic symptoms (DRESS) inpatients admitted in our center and possible factors associated with it. Methods: This was a cross-sectional observational study of patients with DRESS admitted from January 2018 to December 2020. Data were entered in MS Excel and analyzed using SPSS software. Results: Eighty-four consecutive patients who were diagnosed as DRESS were included in the study. The most common inciting drug was phenytoin and the most common indication for starting phenytoin was traumatic brain injury (TBI) to prevent seizures. DRESS to phenytoin after neurotrauma (NT) was more in patients who sustained combined extradural (EDH) and subdural hematoma (SDH), and those were managed conservatively for NT. None of the patients recognized fever as an initial feature of DRESS and did not stop the drug. More than one-third of patients with erythema multiforme (EM) like rash developed drug induced liver injury(DILI). The majority of patients who had sub-arachnoid hemorrhage (SAH) developed DILI. Conclusion: Phenytoin though time-tested and cost-effective for prevention of seizures after TBI, it very commonly leads to DRESS which adds to the morbidity and rarely mortality of patient. In this present era of increasing road traffic accidents, using newer non-aromatic anticonvulsants may be more beneficial than phenytoin. The patients should be made aware of the likely time DRESS can occur, the earliest symptom of DRESS, and the need to stop the drug at the earliest.

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Clinical Study of Drug Reaction With Eosinophilia and Systemic Symptoms (Dress) – With Special Focus on the Inciting Drug and the Indication for Starting the Drug

Zacharia

Seena

Shaj

et al. 2022

Asian J Pharm Clin Res

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Kawasaki disease for dermatologists

Gupta

Singh

2016

Indian Dermatol Online J

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Kawasaki disease (KD) is a systemic vasculitis that mostly affects children below the age of 5. The vasculitis involves arteries of medium size, especially the coronaries. Various etiologies have been proposed including association with micro-organisms, bacterial superantigens, and genetic factors, however, the exact cause remains unknown. There is no specific laboratory test for KD. Diagnosis is clinical and depends upon the presence of fever for ≥5 days and 4 or more of five principal features, viz. polymorphous exanthem, extremity changes, mucosal changes involving the lips and oral cavity, bilateral bulbar conjunctival injection, and unilateral cervical lymphadenopathy. The term “incomplete KD” refers to the presence of fever and less than four principal clinical features. Recognition of this group of patients is important because it is usually seen in infants and risk of coronary abnormalities is increased probably because of delays in diagnosis. However, what appears to be “incomplete” at a given point of time may not actually be so because some of the features may have already subsided and others may evolve over time. Hence, a detailed dermatological examination is warranted in all cases, especially in incomplete KD, to ensure timely diagnosis. Although KD is a self-limiting disease in most patients, coronary artery abnormalities (CAAs) including coronary dilatations and aneurysms may develop in up to 25% of untreated patients. CAAs are the most common cause of morbidity and mortality in patients with KD. Treatment is aimed at reducing inflammation and consists of intravenous immunoglobulin (IVIG) along with aspirin. Despite treatment, some patients may still develop CAAs, and hence, long-term follow up is of utmost importance.

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A Challenging Case of Toxic Epidermal Necrolysis in a 2 Year Old Child With Review of Literature

Singh¹,

Mitra²,

Chopra³

et al. 2021

Indian J Paediatr Dermatol

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Severe Cutaneous Adverse Reactions to Drugs

Cited by 3 publications

References 228 publications

Clinical Study of Drug Reaction With Eosinophilia and Systemic Symptoms (Dress) – With Special Focus on the Inciting Drug and the Indication for Starting the Drug

Clinical Study of Drug Reaction With Eosinophilia and Systemic Symptoms (Dress) – With Special Focus on the Inciting Drug and the Indication for Starting the Drug

Kawasaki disease for dermatologists

A Challenging Case of Toxic Epidermal Necrolysis in a 2 Year Old Child With Review of Literature

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