Clinico pathological study of adverse cutaneous drug reactions

Balamurugan, L (2018) Clinico pathological study of adverse cutaneous drug reactions. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Adverse cutaneous drug reactions are commonly encountered in modern day clinical practice. They range from benign cutaneous reactions to severe cutaneous adverse drug reactions (SCAR). With a wide range of new drugs entering the market, the possibility of new drug reactions or different presentation of a common drug reaction should be considered. AIMS AND OBJECTIVES: To assess the epidemiology of adverse cutaneous drug reactions in our set up, the drugs commonly involved, various clinical presentations, and to correlate the clinical, histological and biochemical investigations. MATERIALS AND METHODS: The study was conducted in Department of Dermatology, RGGGH & MMC, Chennai, in patients, during November 2016 to September 2017. Patients who were more than 12 years of age and were willing for follow up were included in the study after getting approval from institutional ethics committee. Study Design: Prospective observational study. Study Population: A total of 36 patients with signs and symptoms of adverse drug reactions, who attended the OPD during the study period. Method: Details regarding the history, duration and course of the disease and co morbidities were collected, complete dermatological and systemic examination was done and the results were tabulated and analysed. OBSERVATIONS AND RESULTS: The incidence of adverse cutaneous drug reactions in our study population was 0.949 per 1000 person years. Mean age at presentation was 39.33± 20.13 years with a male to female ratio of 1.25:1. 69% of patients presented with benign cutaneous reactions and 31% with SCAR. Itching (64%) was the most common symptom. Fixed drug eruption (28%) was the commonest presentation and NSAIDs (33%) were the commonest offending drug. SJS / TEN (19%) was the commonest SCAR and anticonvulsants were the commonest offending drug in SCAR. Absolute eosinophil counts of more than 1000/mm³ were seen in 82% and abnormality in liver parameters in 30.5% of patients with SCAR. Spongiosis, necrotic keratinocytes and basal cell degeneration were the commonest histopathological finding with extensive changes seen in cases of SCAR. CONCLUSION: Adverse drug reactions should be diagnosed and managed early to prevent the morbidity and mortality, especially in cases of SCAR. Elevated eosinophil counts might have a prognostic significance in severe cases and histopathological examination can be helpful when the clinical presentation mimics common dermatological disorders.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Adverse cutaneous drug reactions (ACDR) ; severe cutaneous adverse drug reactions (SCAR) ; fixed drug eruption (FDE) ; absolute eosinophil count (AEC).
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 19 Jul 2018 02:50
Last Modified: 19 Jul 2018 02:50

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