Adverse cutaneous drug reaction

Abstract

In everyday clinical practice, almost all physicians come across many instances of suspected adverse cutaneous drug reactions (ACDR) in different forms. Although such cutaneous reactions are common, comprehensive information regarding their incidence, severity and ultimate health effects are often not available as many cases go unreported. It is also a fact that in the present world, almost everyday a new drug enters market; therefore, a chance of a new drug reaction manifesting somewhere in some form in any corner of world is unknown or unreported. Although many a times, presentation is too trivial and benign, the early identification of the condition and identifying the culprit drug and omit it at earliest holds the keystone in management and prevention of a more severe drug rash. Therefore, not only the dermatologists, but all practicing physicians should be familiar with these conditions to diagnose them early and to be prepared to handle them adequately. However, we all know it is most challenging and practically difficult when patient is on multiple medicines because of myriad clinical symptoms, poorly understood multiple mechanisms of drug-host interaction, relative paucity of laboratory testing that is available for any definitive and confirmatory drug-specific testing. Therefore, in practice, the diagnosis of ACDR is purely based on clinical judgment. In this discussion, we will be primarily focusing on pathomechanism and approach to reach a diagnosis, which is the vital pillar to manage any case of ACDR.

A study of adverse cutaneous drug reactions in the department of dermatology of a teaching hospital in Jamnagar, India

“…These results are in accordance with earlier studies. 4,7,17 Out of 12 cases of FDE, 7 (41%) were due to paracetamol. Flouroquinolones were involved in 3 (31%) cases followed by 2 (10%) cases due to ibuprofen and aspirin.…”

“…3 An adverse cutaneous drug reaction (ACDR) is any undesirable change in the structure or function of the skin, its appendages or mucous membranes and it encompasses all adverse events related to drug eruption, regardless of the etiology. 4 Any skin disorder can be imitated, induced, or aggravated by drugs. Many of the commonly used medicines have reaction rates over 1%.…”

Common adverse cutaneous drug reaction patterns and the causative drugs in Malaysia

“…1 The prevalence of ACDR is about 0.16 to 1.35%. 2,3 However, this may be a deceptively low figure secondary to under-reporting.…”

Cutaneous drug reactions notified by ADR monitoring centre in a tertiary care hospital of Bihar

“…2 Cutaneous drug reactions is defined as any undesirable change in the structure or function of skin, its appendages or mucous membranes, encompassing all adverse events related to drug eruption regardless of etiology. 3 Of the various adverse reactions to drugs, cutaneous drug reactions are the most frequent, with an incidence of 10-30% of all the reported ADRs.…”