Adverse cutaneous reactions to psychotropic drugs

Abstract

IntroductionPsychotropic drugs are not devoid of side effects, especially cutaneous reactions, some of which are severe, and can jeopardize functional and life prognosis. The Aim of this study is to highlight the epidemiological and clinical features of severe cutaneous adverse reactions (SCARs) due to psychotropic drugs. Materials and methodsWe carried out a retrospective study over a period of 10years, It concerned all patients hospitalized in our dermatology department for SCARs induced by psychotropic drugs. The imputability was confirmed by the French methodology of Bégaud et al. ResultsWe identified 41 cases, of which 18 patients (43.9%) were being treated with psychotropic drugs for the first time. The most incriminated psychotropic drugs were: carbamazepine (n=16), phenobarbital (n=8), lamotrigine (n=5). Clinical forms were: drug reaction with eosinophilia and systemic symptoms syndrome (n=30), Stevens–Johnson syndrome (n=4), overlap syndrome (n=1), drug-induced vasculitis (n=4), symmetrical drug-related intertriginous and flexural exanthema syndrome (n=1), photosensitivity (n=1). Complications were as follows: hepatic cytolysis (75%), cholestasis (60%), functional renal failure (43%). Carbamazepine was statistically correlated with renal damage and cholestasis (P=0.013) and phenobarbital was associated with a risk of hepatic cytolysis (P=0.027). ConclusionCutaneous side effects to psychotropic drugs remain rare<2%. In our study, we found that rapid or recent increase in dose of anticonvulsants, or the combination of several psychotropic drugs is the most common cause of SCARs. We also found that carbamazepine was more likely to cause renal damage and cholestasis, whereas chlorpromazine was statistically correlated with hepatic cytolysis.