Epidemiology of severe cutaneous adverse drug reactions in a University Hospital: a Five-year review


Introduction: Severe cutaneous adverse drug reactions (SCAR) is seen in ≤5% of all hospitalized patients.  It includes Stevens-Johnson syndrome/toxic epidermal necrolysis spectrum (SJS/TEN), drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS) and acute generalized exanthematous pustulosis (AGEP).

Objectives: The main objective was to determine the epidemiological characteristics of SCAR patients at a tertiary hospital from 2011-2015. Specifically, it aimed to determine the prevalence, demographic characteristics and clinical profile of SCAR patients.

Methods: All SCAR patients from 2011-2015 were studied through a single-center, retrospective, descriptive, cross-sectional study.

Results: Sixty-eight SCAR cases were diagnosed from 2011-2015 with a prevalence rate of 6.25 per 10,000 people. Majority were 46-55 years old with slight female predominance.  The most common SCAR was DIHS/DRESS (50%), followed by SJS/TEN (30%) and AGEP (20%). Eight percent had previous drug reactions, 69% had co-morbidities and 90% were diagnosed clinically without biopsy.  The antibiotics was the most common culprit drug category followed by allopurinol and anticonvulsants.  Prompt withdrawal of culprit drug/s, supportive therapy, systemic steroids and antihistamine, topical emollients and saline compress were mainstay of treatment.  Mortality rate was 4% for all SCAR categories.

Conclusion: The epidemiology of SCAR in this study is similar to those reported in other literature. The adults were commonly involved; DIHS/DRESS was the most common SCAR with antibiotics being the most common culprit. Prompt withdrawal and supportive therapy were essential. Systemic steroid, antihistamine; topical emollients and saline compress resulted in improvement of patients. In contrast, there was lower prevalence rate with slight female predominance; and lower mortality rate even with the use of systemic steroids.

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