Pharmacovigilance of cutaneous adverse drug reactions-a focused research in times of COVID pandemic

Abstract

Severe cutaneous adverse drug reactions are limiting, ranging from 5 cases per million including acute generalized exanthematous pustulosis (AGEP) and drug reaction with eosinophilia systemic symptoms (DRESS) to 1 case per million of toxic epidermal necrolysis. Cutaneous adverse drug reactions following drug therapy of COVID-19 are not uncommon. Viral infection and drug interactions predisposes to the development of cutaneous adverse drug reactions, as already documented with Epstein-Barr virus, cytomegalovirus, human herpesvirus 6, and HIV. The Adverse drug reaction monitoring center of CNMCH has actively participated in pharmacovigilance programme of India by reporting few adverse drug reactions including the following cases. It is iterated that pharmacovigilance programme extends beyond just mere detection and reporting of adverse drug reactions and also should involve in assessment and understanding the cases, thus facilitating control and prevention of these cases. Particularly in times of COVID pandemic there has been continuous amendment in the treatment guidelines both at the central and state level. Incorporation of various antibiotics, antiparasites and antiviral drugs for the treatment of COVID, has potentiated the risk of development of drug allergies. Admittedly, the detailed understanding of drug allergy cases has been in general constrained with a relative lack of access to standardized laboratory diagnostic tests. Focused research is the need of the hour in order to understand the drug allergies better. In this study we have included those cases reported by department of medicine and dermatology of Calcutta national medical college and hospital in the past six months. All the cases were COVID positive and were treated conservatively by de-challenging the culprit drug and administration of antihistamines, topical steroids, while a few was put on systemic steroid therapy. There were six such reported cases of cutaneous adverse drug reaction following COVID treatment. There were four cases of maculopapular drug eruptions, while the other cases were diagnosed with fixed drug eruptions and acute generalized exanthematous pustulosis respectively. All the cases were reported under pharmacovigilance programme of India.