DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20185371

A clinicoepidemiological study of fixed drug eruptions at a tertiary centre of North India

Rohini Sharma, Sameer Abrol

Abstract


Background: Various studies have found the overall incidence of cutaneous adverse drug reactions (CADR’s) in developed countries as 1-3%, while the incidence in developing countries is thought to be higher between 2 and 5%. FDEs’ share is seen to be about 15 -30% of all CADR’s as reported in various studies. Aim of the research work was to study the clinical and epidemiological features of fixed drug eruptions and to identify probable culprit drug or drugs using Naranjo ADR probability scale and to provide information to the patient regarding the drug responsible for his/her drug rash.

Methods: A total of 180 patients of fixed drug eruptions were taken up for study who presented to skin OPD at a tertiary centre of North India. Diagnosis was made on the basis of history of drug intake prior to drug eruption, repetition of similar lesions on same as well as new sites on intake of same drug with improvement of skin lesions on discontinuation of the causative drug. Further on examination, skin lesions with typical morphology compatible with FDE were seen. Causality of the FDE was assessed according to the NARANJO ADR probability scale.

Results: A total of 180 patients of FDE were studied. Males outnumbered the females. The most common class of drug implicated was antimicrobials seen in 115 patients followed by NSAIDS 65 patients. Regarding the clinical presentation both skin and mucosal involvement was seen. The most common skin lesions were erythematous to hyperpigmented and violaceous macules followed by bullous FDE.

Conclusions: In summary, early recognition of FDE is important not only for the dermatologists but also for the clinicians of other specialties, so that the culprit drug is recognized and stopped immediately. Drug reactions are a common reason for litigation and has medicolegal pitfalls.


Keywords


CADR, Causality, Fixed drug eruptions

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References


Nandha R, Gupta A, Hashmi A. Cutaneous adverse drug reactions in a tertiary care teaching hospital: A North Indian perspective. Inter J App Basic Med Res. 2011 Jan;1(1):50-3.

Butler DF. Fixed drug eruptions. E-medicine Dermatology; 2010.

Svensson CK, Cowen EW, Gaspari AA. Cutaneous drug reactions. Pharmacological reviews. 2001 Sep 1;53(3):357-79.

Patel RM, Marfatia YS. Clinical study of cutaneous drug eruptions in 200 patients. Ind J Dermatol Venereol Leprol. 2008 Jul 1;74(4):430.

Lee HY, Tay LK, Thirumoorthy T, Pang SM. Cutaneous adverse drug reactions in hospitalised patients. Singapore Med J. 2010;51(10):767.

Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Thera. 1981 Aug 1;30(2):239-45.

Martin T, Hui Li. Severe cutaneous adverse drug reactions: a review on epidemiology, etiology, clinical manifestation and pathogenesis. Chinese Med J. 2008;121(8):756-61.

Mahboob A, Haroon TS. Drugs causing fixed eruptions: a study of 450 cases. Int J Dermatol. 1998;37:833-8.

Ryou JH, Kim JH, Lee MH. A clinicopathological study of fixed drug eruptions. Korean J Dermatol. 1998;36(1):30-6.

Sehgal VN, Gangwani OP. Fixed drug eruption. current concepts. Int J Dermatol. 1987;26:67-4.

Sharma VK, Dhar S, Gill AN. Drug related involvement of specific sites in fixed eruptions: a statistical evaluation. J Dermatol. 1996;23:530-4.

Kanwar AJ, Bharija SC, Singh M, Belhaj MS. Ninety-eight fixed drug eruptions with provocation tests. Dermatologica. 1988;177:274-9.

Gupta R. Drugs causing fixed drug eruptions: confirmed by provocation tests. Indian J Dermatol Venereol Leprol. 2003;69:120-1.

Pudukadan D, Thappa DM. Adverse cutaneous drug reactions: clinical pattern and causative agents in a tertiary care center in South India. Indian J Dermatol Venereol Leprol. 2004;70:20-4.