背景:实际上,所有医生在日常临床实践中都会遇到各种可疑的皮肤药物不良反应(CADR)。皮肤和粘膜是许多药物不良反应的早期表现的最常见区域。皮肤药物不良反应分为良性或严重。药疹的临床表现可从轻度斑丘疹性皮疹到重度皮肤药物不良反应(SCARs)。
目的:确定CADR的各种临床和形态学表现,并确定引起CADR的罪魁祸首药物和常见药物。
方法:在皮肤科门诊(OPD)就诊的临床特征疑似CADR的患者,性病,和麻风病(DVL)在2021年12月至2022年11月在大东方医学院和医院(GEMS),Srikakulam,安得拉邦,印度,被考虑用于研究。这是一个横截面,观察性研究。详细记录患者的临床病史。这包括主要投诉(症状,发病部位,持续时间,药物史,药物给药和皮肤病变出现之间的潜伏期),家族史,相关疾病,病变的形态,和粘膜检查。停药后,观察到皮肤病变和全身特征的改善.完整的一般检查,系统检查,皮肤病学测试,并进行粘膜检查。
结果:共有102名患者参与了这项研究,其中男性55人,女性47人。男女比例为1.17:1,男性占多数。男性和女性最常见的年龄组为31至40岁。瘙痒是56例患者的主要主诉(54.9%)。荨麻疹的平均潜伏期最短(2.13/-0.99小时),苔藓样药疹的平均潜伏期最长(4.33/-3.93个月)。大多数患者在服用药物一周后出现症状(53.92%)。38.23%的患者存在类似的投诉史。镇痛药和退热药(39.2%)是最常见的罪魁祸首药物,其次是抗菌药物(29.4%)。在镇痛药和退烧药中,醋氯芬酸(24.5%)是最常见的罪魁祸首药物。89例(87.25%)患者出现良性CADR,13例(12.74%)患者出现严重皮肤不良反应。常见的CADR为药物诱导的exanthem(27.4%)。在一名患者中观察到伊马替尼诱导的寻常型银屑病和锂诱导的头皮银屑病。严重皮肤不良反应13例(12.74%)。抗惊厥药,非甾体抗炎药(NSAIDs),和抗菌药物是SCAR的罪魁祸首。三名患者出现嗜酸性粒细胞增多,9名患者出现肝酶紊乱,7名患者出现肾脏异常,1例SCAR中毒性表皮坏死松解症(TEN)患者死亡。
结论:在给患者开任何药物之前,需要获得详细的药物史和药物反应家族史。应建议患者避免非处方药和自我给药。如果发生药物不良反应,建议避免重新使用罪魁祸首药物。必须准备好药物卡并发给病人,提到了罪魁祸首药物以及交叉反应药物。
BACKGROUND: Practically all physicians encounter a diverse range of suspected cutaneous adverse drug reactions (CADRs) in their daily clinical practice. The skin and mucosa are the most often encountered areas for the early presentation of numerous adverse drug reactions. Cutaneous adverse drug reactions are classified as benign or severe. The clinical manifestations of drug eruptions can range from mild maculopapular exanthema to severe cutaneous adverse drug reactions (SCARs).
OBJECTIVE: To determine the varied clinical and morphological presentations of CADRs and to identify the culprit drug and common drugs causing CADRs.
METHODS: Patients with clinical features suspected of CADRs presenting to the outpatient department (OPD) of dermatology, venereology, and leprosy (DVL) between December 2021 to November 2022 at Great Eastern Medical School and Hospital (GEMS), Srikakulam, Andhra Pradesh, India, were considered for the
study. This was a cross-sectional, observational
study. The patient\'s clinical history was taken in detail. This included chief complaints (symptoms, site of onset, duration, drug history, latency time between drug administration and the appearance of cutaneous lesions), family history, associated diseases, the morphology of lesions, and mucosal examination. Upon drug discontinuation, improvement in cutaneous lesions and systemic features were noted. A complete general examination, systemic examination, dermatological tests, and mucosal examination were performed.
RESULTS: A total of 102 patients were involved in the
study, of whom 55 were males and 47 were females. The male-to-female ratio was 1.17:1, with a slight male majority. The most common age group was 31 to 40 years for both males and females. Itching was the predominant complaint in 56 patients (54.9%). The mean latency period was shortest in urticaria (2.13+/- 0.99 hours) and longest in lichenoid drug eruption (4.33+/- 3.93 months). Most patients developed symptoms after a week of taking the drug (53.92%). A history of similar complaints was present in 38.23% of patients. Analgesics and antipyretics (39.2%) were the most common culprit drugs followed by antimicrobials (29.4%). Among analgesics and antipyretics, aceclofenac (24.5%) was the commonest culprit drug. Benign CADRs were observed in 89 patients (87.25%), and severe cutaneous adverse reactions (SCARs) were observed in 13 patients (12.74%). The common CADRs presented were drug-induced exanthem (27.4%). Imatinib-induced psoriasis vulgaris and lithium-induced scalp psoriasis were observed in one patient each. Severe cutaneous adverse reactions were observed in 13 patients (12.74%). Anticonvulsants, nonsteroidal anti-inflammatory drugs (NSAIDs), and antimicrobials were the culprit drugs for SCARs. Eosinophilia was present in three patients, deranged liver enzymes was present in nine patients, a deranged renal profile was present in seven patients, and death occurred in one patient with toxic epidermal necrolysis (TEN) of SCARs.
CONCLUSIONS: Before prescribing any drug to a patient, a detailed drug history and family history of drug reactions need to be obtained. Patients should be advised to avoid over-the-counter usage of medications and self-administration of drugs. If adverse drug reactions occur, it is advised to avoid readministration of the culprit drug. Drug cards must be prepared and given to the patient, mentioning the culprit drug as well as the cross-reacting drugs.