Severe cutaneous adverse reactions in a tertiary care center in Jamaica

Abstract

BackgroundSevere cutaneous adverse reactions (SCARs) are associated with morbidity and mortality. ObjectiveThe aim was to determine the different types of SCARs, their morphology, common offending drugs, interventions, and outcomes. MethodsA retrospective cohort study was conducted of all patients admitted to the dermatology service at the University Hospital of the West Indies with Stevens-Johnson syndrome (SJS), Stevens-Johnson syndrome/toxic epidermal necrolysis overlap (SJS/TEN), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP) between January 1, 2012 to June 1, 2022. ResultsFifty-one cases (51) met the inclusion criteria for SCAR. SJS, SJS/TEN overlap and TEN together accounted for 71.2% of cases. SCARs were most frequent in the 4th, 5th and 6th decades of life and there was a female preponderance.Antibiotics (31%) and anticonvulsants (29%) were the most common causative agents for SCARs. Most patients had at least one complication. The liver was the most common extracutaneous organ affected.Mortality was 7.8%. The main cause of death was sepsis. LimitationsResults were not generalizable. There was missing data and loss to follow-up. ConclusionJudicious use of antimicrobials and corticosteroids may be beneficial in treatment of severe cutaneous drug reactions.