Cutaneous Adverse Drug Reactions (CADRs)—Statistical Analysis of the Causal Relationship between the Drug, Comorbidities, Cofactors, and the Cutaneous Reaction—A Single-Centered Study

Abstract

Cutaneous adverse drug reactions (CADRs) are among the most common types of drug hypersensitivity reactions. The purpose of this study was to evaluate the clinical spectrum of CADRs and to determine the causal relationship between drugs, comorbidities, cofactors or concomitant symptoms, and cutaneous reactions. A retrospective hospital-based study was carried out over a period of 10 years at the Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology at the University of Warmia and Mazury in Olsztyn to record various CADRs, comorbidities, cofactors, and the suspected drug in hospitalized patients. The data were subjected to statistical analysis. CADRs were diagnosed in a total of 140 patients, 32.14% of whom were men and 67.86% of whom were women. The mean age was 66.33 years. The most commonly suspected drugs were Allopurinol 12.86%, Amoxicillin with clavulanic acid 10%, Amoxicillin 9.29%, Paracetamol 6.43%, Metronidazole 5%, and Carbamazepine 5%. Attention should be paid to the possibility of using a substitute for a suspected drug if CADRs arise, or discontinuing a drug that is unjustifiably overused. The results of the present study should also prompt research into a potential treatment that could be implemented concurrently with a drug that has a high predisposition to cause CADRs.

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“…In almost all the papers, ABs were one of the major causes of cADRs or ScADRs. The lowest frequency was found to be between 5% -10% [15,26,42] and highest being 81.13% [70] followed by 73.8% [71]. Several other studies also found a very high frequency of AB-associated cADRs like- Wong et al, (2019) [72] 66.1%, Dimri, Raina, Thapliyal, & Thawani, (2016) >69% [11], and Verma et al, 56% [73] (Table 2).…”

“…It is a delayed hypersensitivity reaction. There are pruritic, erythematous skin eruptions, especially on the flexural intertriginous areas [42] like inguinal and/or gluteal regions. Well-demarcated lesions with eczema, scaling or desquamation of affected skin are common features.…”

“…Multiorgan involvement in anaphylaxis leads to hypotension, bronchospasm, and GIT symptoms. Culprit drugs are antibiotics like-penicillin, cephalosporins, tetracyclines, and sulfonamides besides other drugs like-general anesthetics, phenytoin, morphine, codeine, NSAIDs, ACE inhibitors [12,[17][18][40][41][42].…”

The mixed spongiotic and interface reaction pattern: A study of clinical and histopathologic findings

“…Of note, the prevalence of immunosuppression, malignancy, and autoimmune disease in our patient population was quite high (47%, 47%, and 18%, respectively). While our case population was drawn exclusively from a single academic tertiary‐care facility, and thus likely overrepresents more complex and hospitalized patients, these numbers are still notably high, even compared to other studies of CADRs 28–30 . The immune dysregulation seen in these conditions is believed to be a major contributor to CADR development 15 .…”

“…While our case population was drawn exclusively from a single academic tertiary‐care facility, and thus likely overrepresents more complex and hospitalized patients, these numbers are still notably high, even compared to other studies of CADRs. 28 , 29 , 30 The immune dysregulation seen in these conditions is believed to be a major contributor to CADR development. 15 Determining specific diagnostic criteria for drug eruption is especially important for these patients, as CADR may present similarly to other serious conditions requiring specific management, including paraneoplastic syndromes, autoimmune diseases, GvHD, and infections.…”