Cutaneous Drug Reactions Research Articles

Disease severity and status in Stevens-Johnson syndrome and toxic epidermal necrolysis: Key knowledge gaps and research needs.

Stevens–Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are on a spectrum of cutaneous drug reactions characterized by pan-epidermal necrosis with SJS affecting < 10% of body surface area (BSA), TEN > 30%, and SJS/TEN overlap between 10 and 30%. Severity-of-illness score for toxic epidermal necrolysis (SCORTEN) is a validated tool to predict mortality rates based on age, heart rate, BSA, malignancy and serum urea, bicarbonate, and glucose. Despite improved understanding, SJS/TEN mortality remains constant and therapeutic interventions are not universally accepted for a number of reasons, including rarity of SJS/TEN; inconsistent definition of cases, disease severity, and endpoints in studies; low efficacy of interventions; and variations in treatment protocols. Apart from mortality, none of the other endpoints used to evaluate interventions, including duration of hospitalization, is sufficiently standardized to be reproducible across cases and treatment centers. Some of the gaps in SJS/TEN research can be narrowed through international collaboration to harmonize research endpoints. A case is made for an urgent international collaborative effort to develop consensus on definitions of endpoints such as disease status, progression, cessation, and complete re-epithelialization in interventional studies. The deficiencies of using BSA as the sole determinant of SJS/TEN severity, excluding internal organ involvement and extension of skin necrosis beyond the epidermis, are discussed and the role these factors play on time to healing and mortality beyond the acute stage is highlighted. The potential role of artificial intelligence, biomarkers, and PET/CT scan with radiolabeled glucose as markers of disease status, activity, and therapeutic response is also discussed.

Case Report on Phenytoin-Induced Toxic Epidermal Necrolysis

Toxic epidermal necrolysis is a cutaneous drug reaction which is a severe adverse effect that predominantly involves the skin and mucous membrane. Phenytoin is an anti-epileptic medication that belongs to the hydantoin class. Here we are going to present a case of 50-year-old male patient with phenytoin induced toxic epidermal necrolysis. The outcome of this study was to determine the severity of the adverse reaction and its management to improve the patient condition. &#x0D; Keywords: Toxic epidermal necrolysis, phenytoin, erythromatous, adverse drug reaction, body surface area.

159 Diagnostic overlap of drug-induced acute interstitial nephritis with cutaneous involvement and drug-induced hypersensitivity syndrome

A common clinical dilemma is distinguishing maculopapular exanthem (MPE) with systemic symptoms from severe cutaneous drug reactions, such as drug-induced hypersensitivity syndrome (DIHS). Drug-induced acute interstitial nephritis (DI-AIN) with MPE can be especially challenging to differentiate from DIHS with renal involvement. It is crucial to distinguish DI-AIN from DIHS as the prognosis and treatment differ. Our goal was to estimate the percentage of published DI-AIN cases meeting RegiSCAR criteria for DIHS and characterize the outcomes.

A cross-sectional study of adverse cutaneous drug reactions with special reference to reaction time

Background: Adverse cutaneous drug reactions (ACDRs) present with different morphologies and times of onset. Knowledge about the common drugs causing them, their reaction time (time interval between drug intake and the onset of symptoms), and the clinical presentations are helpful in identifying an offending drug, especially in the setting of multiple drug therapies, thereby reducing the morbidity and mortality associated with them. Aims: This study aims to identify causative drugs and clinical patterns of ACDRs in a tertiary care center and to estimate their reaction time. Methods: Sixty-two patients diagnosed to have ACDRs who attended the department of dermatology of a tertiary care teaching hospital during an 18-month period were selected for the study. They were classified into certain, probable, or possible categories as per the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) classification. The frequency of each type of drug reaction, common causative agents, and reaction time of different drug reactions was analyzed. Results: Of the 62 patients, 40 (64.5%) were probable, 18 (29%) possible, and 4 (6.4%) were certain. The most common types of reactions encountered were fixed drug eruption (FDE) (13, 21%), drug hypersensitivity syndrome (12, 19.4%), and maculopapular rash (9, 14.5%). As a single group of drugs, antimicrobials were the most common causative agents (23, 37%) followed by anticonvulsants (16, 25.8%). As an individual drug, phenytoin was the most common causative agent (10, 16.1%), followed by paracetamol (7, 11.3%) and isoniazid (5, 8.1%). Reaction time varied from less than an hour for FDE and urticaria to 3–4 months for exfoliative dermatitis, lichenoid eruption, and folliculitis. Limitations: Small sample size was the major limitation. Conclusion: Reaction time varied from less than 24 h in FDE, urticaria, and angioedema to 3–4 months in exfoliative dermatitis, lichenoid eruption, and folliculitis.

Study of Clinicodemographic Profile of Adverse Cutaneous Drug Reactions in Indian Perspective

Background: Cutaneous adverse drug reactions are an important group of disorders which pose considerable amount of diagnostic and therapeutic challenges. The incidence of CADRs is estimated to be 1–2% in the general population. Newer insights have been developing in the field of factors affecting CADRs and the need for studies in the Indian population regarding the newer trends in cutaneous adverse effects. Materials and Methods: A prospective and observational study was conducted in the Department of Pharmacology and Collaboration with Department of Dermatology in MGM Medical College and LSK Hospital. All cases of suspected CADRs in patients with systemically administered drugs were actively screen by a senior dermatologist. Causality assessment was done by a Pharmacologist using WHO UMC scale. Only those cases where the causality was certain probable/likely were recorded. Results: This sampling comprised of 77 CADRs over a period of 1 year from June 2012 to May 2013. The clinical pattern and spectrum of CADRs were studied in 77 subjects. A wide clinical spectrum of CADRs ranging fixed drug eruptions to serious Stevens Johnson syndrome (SJS) was observed. The predominant pattern of reactions observed was fixed drug eruptions FDE (35.1%) followed by acneiform eruptions (23.4%), erythema multiforme (9.1%), and phototoxic drug reactions (7.8%). The antimicrobials causing FDE were macrolides, cephalosporins, and fluoroquinolones. Among the NSAIDs causing FDE, most were due to diclofenac (70%). CADRs were seen most commonly in the 31–40 (26%) years age group followed by 11–20 (24.7%) years and 41–50 (19.5%) years with mean age 32.09 years. Only 5.2% patients were more than 60 years, oldest being 67 years. Antimicrobials were the most common drug group incriminated in 34% patients followed by NSAIDs in 29% cases and steroids in 25% cases. Among NSAIDs, maximum number of CADRs were caused by ibuprofen (40.9%) followed by diclofenac (36.4%), paracetamol (9%), aceclofenac (9%), and nimesulide (4.5%). Serious reactions were infrequent. Conclusion: Most of the reactions were mild (53%) to moderate (42%) requiring no major medical intervention. However, a larger and multi-centric study needs to be conducted across the state to obtain more information about CADRs among the state population.

Antiepileptic Drug Adverse Cutaneous Reaction in Childhood

AbstractAntiepileptic drug (AED) side effects can result in treatment failure, morbidity, and mortality. Adverse cutaneous drug reactions (ACRs) frequently occur within the first 2 to 3 months of drug use. We wanted to discuss antiepileptic ACRs in childhood in this study. This was a study of 37 pediatric patients who were diagnosed with ACR and treated with AED in the last 5 years. Over a 5-year period, 37 (1.8%) of the 2,064 epilepsy patients had ACRs. There were 23 (62%) male patients and 14 (38%) female patients. Patients had a median age of 6 years (interquartile range: [IQR]: 3.5–10). The ACRs occurred in a median of 20 (IQR: 14–30) days. There were 28 (75%) patients receiving monotherapy and 9 (25%) patients receiving polytherapy. Overall, 22 (59.5%) of the 37 patients used aromatic drugs (AD), while 15 (40.5%) used nonaromatic drugs (NAD). Morbilliform eruptions accounted for the majority of ACRs (84%). Valproic acid (54%) was the most frequently used AED that resulted in ACRs. There was no significant difference in terms of eruption time, gender, or age between AD and NAD. Within 1 to 2 months of initiating a new AED, patients should be closely monitored for ACRs. If an ACR develops for one AED, greater caution should be taken when initiating the other AED. Although it is well established that ADs cause more skin reactions, we found that one of the NADs, valproic acid, causes more skin reactions.

Scoring Assessments in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

Epidermal necrolysis, the unifying term for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), is a severe cutaneous drug reaction associated with high morbidity and mortality. Given the rarity of this disease, large-scale prospective research studies are limited. Significant institutional and geographical variations in treatment practices highlight the need for standardization of clinical assessment scores and prioritization of research outcome measures in epidermal necrolysis. At the present, clinical assessment is typically simplified to total body surface area (BSA) involvement, with little focus on morphology. Validated clinical scoring systems are used as mortality prognostication tools, with SCORTEN being the best-validated tool thus far, although the ABCD-10 has also been recently introduced. These tools are imperfect in that they tend to either overestimate or underestimate mortality in certain populations and are not designed to monitor disease progression. Although mortality is often used as a primary endpoint for epidermal necrolysis studies, this outcome fails to capture more nuanced changes in skin disease such as arrest of disease progression while also lacking a validated skin-directed inclusion criterion to stratify patients based on the severity of skin disease at study entry. In addition to mortality, many studies also use BSA stabilization or time to re-epithelialization as endpoints, although these are not clearly defined morphologically, and inter- and intra-rater reliability are unclear. More specific, validated cutaneous assessment scores are necessary in order advance therapeutic options for epidermal necrolysis. In this review, we summarize the strengths and weaknesses of current clinical assessment practices in epidermal necrolysis and highlight the need for standardized research tools to monitor cutaneous involvement throughout the hospitalization.

Advances in Our Understanding of the Interaction of Drugs with T-cells: Implications for the Discovery of Biomarkers in Severe Cutaneous Drug Reactions.

Drugs can activate different cells of the immune system and initiate an immune response that can lead to life-threatening diseases collectively known as severe cutaneous adverse reactions (SCARs). Antibiotics, anticonvulsants, and antiretrovirals are involved in the development of SCARs by the activation of αβ naïve T-cells. However, other subsets of lymphocytes known as nonconventional T-cells with a limited T-cell receptor repertoire and innate and adaptative functions also recognize drugs and drug-like molecules, but their role in the pathogenesis of SCARs has only just begun to be explored. Despite 30 years of advances in our understanding of the mechanisms in which drugs interact with T-cells and the pathways for tissue injury seen during T-cell activation, at present, the development of useful clinical biomarkers for SCARs or predictive preclinical in vitro assays that could identify immunogenic moieties during drug discovery is an unmet goal. Therefore, the present review focuses on (i) advances in the understanding of the pathogenesis of SCARs reactions, (ii) a description of the interaction of drugs with conventional and nonconventional T-cells, and (iii) the current state of soluble blood circulating biomarker candidates for SCARs.

Post-injection Complications. Nicolau Syndrome as a Consequence of Local Irritant Effects of Drugs, Including Antiseptics, Local Anesthetics, NSAIDs, Steroids and Anticoagulants

It has been shown that some drugs considered to be of good quality today can cause an iatrogenic disease known as Nicolau syndrome. Nicolau syndrome is a rare cutaneous drug reaction occurring after injection many drugs. This disease has been found to be caused by the very strong local irritant activity of drug solutions. It turned out that the standard for assessing the quality of drug solutions does not include assessment of their osmotic activity and the strength of their local irritating effect on various tissues during injection. At the same time, drug solutions produced by different pharmaceutical companies may contain, in addition to the main ingredients, other ingredients (hydrochloric acid, sodium hydroxide, propylene glycol, etc.). Very often the additional ingredients increase the osmotic activity of the drug solution, which is not controlled today, so it remains unknown. This is why drug solutions produced by some pharmaceutical companies can have hypertonic activity, which can sometimes by ignorance reach values that are incompatible with the vital activity of human body tissue cells. Therefore, injections of such drug solutions can have a very strong dehydrating effect on the tissue cells at the injection sites, have a local irritating and cauterizing effect. It has been shown that even steroid solutions in some manufacturers may have excessive hypertonic and acidic activity, which gives them a local irritating effect. This is why in some cases the injection of a steroid solution does not eliminate, but rather increases local inflammation and causes necrosis. Therefore, to exclude postinjection necroses and abscesses, it is proposed to include an assessment of the osmotic activity and local irritant effect of drug solutions in the drug quality control standard and to prohibit the injection of drug solutions with excessive hypertonic activity.

Severe Sunburn-Like Adverse Cutaneous Drug Reaction in a Patient on Treatment with Rifaximin: A Rare Case of Acute Phototoxic Drug Reaction

This paper describes an unreported case of a rifaximin-induced phototoxic reaction in an otherwise healthy 24-year-old female (skin type: V). The patient developed malaise, chills, and facial swelling with accompanying redness and itching that began within a day of initiating treatment with rifaximin (200 mg twice daily), and progressively increased over the next 3–4 days. The patient revealed that they had been lying in the sun for hours due to the chills they were experiencing. Over the next 10 days they developed an exaggerated, acute, sunburn-like phototoxic reaction, with blistering over the exposed skin. A skin biopsy showed no evidence of vasculopathy, endothelial damage, or extravasation of red blood cells. The patient was treated successfully with oral prednisolone (30 mg per day for a week), topical mometasone furoate (0.1%) cream applied twice daily, levocetirizine (5 mg per day taken orally), zinc oxide (20.0%) cream applied every 3 hours during daytime, and strict sun avoidance. The possible pathomechanism of rifaximin-induced sunburn is also discussed here.

Clinical aspects and therapeutic approach of drug-induced adverse skin reactions in a quaternary hospital: a retrospective study with 219 cases

BackgroundAdverse drug reactions are frequent, with cutaneous manifestations being the most common. In the hospital environment, the incidence of cutaneous drug reactions varies from 2% to 3%. ObjectiveTo analyze the profile of cutaneous drug reactions, relating clinical forms, suspected medications, histopathological alterations, systemic repercussions, treatment and course. MethodsClinical, retrospective and observational study of patients seen by the Dermatology Interconsultation team from January 2013 to December 2016. ResultsThe frequency of cutaneous drug reactions among the evaluated patients was 13.6%, with 219 cases diagnosed. In 65.7%, the reaction was considered mild, of which the most common was exanthema, while in 34.2%, the reaction was considered severe, with DRESS being the main form of reaction(18.2%). Antibiotics (36.5%) and anticonvulsants (10%) were the most involved drugs. In addition to drug discontinuation, systemic corticosteroids were prescribed in 47% of cases and intravenous immunoglobulin (IVIg) in 4.5%. Of the mild forms, in 62%, expectant management and/or exclusive use of symptomatic treatment was used. Study limitationsRetrospective study, with limitations inherent to this type of investigation; lack of some information in medical records; long evaluation period, with a possible change in external validity. ConclusionThe most frequently identified clinical form was exanthema, and antibiotics and anticonvulsants were the most frequently involved drug classes. About one-third of the patients had severe cutaneous drug reactions, with DRESS being the main one. Cutaneous drug reactions are frequent in clinical practice, and the dermatologist should be called in as soon as possible to assist in the diagnosis and management of these cases.

The assessment of severe cutaneous adverse drug reactions.

SUMMARYSevere cutaneous adverse drug reactions include Stevens-Johnson syndrome, toxic epidermal necrolysis and acute generalised exanthematous pustulosis. These eruptions are a type of delayed hypersensitivity reaction and can be life-threatening.The assessment of a severe cutaneous drug reaction requires a detailed clinical history and examination to identify the culprit drug and evaluate the allergy. Allopurinol, antibiotics and anticonvulsants are often implicated.Patch testing and delayed intradermal testing can assist in determining if the reaction was allergic, however there is limited evidence about the sensitivity and specificity of skin testing in severe cutaneous adverse drug reactions. If the testing is non-conclusive or negative, it is recommended to avoid the suspected culprit drug and any structurally similar drug in future.Any decision to reintroduce a drug should be made after considering the harm–benefit ratio. Caution is also needed if considering a possibly cross-reactive drug in a patient with a history of severe cutaneous adverse drug reactions.

Delayed cutaneous adverse drug reactions to sympathomimetics after oral intake of over-the-counter medications

Sympathomimetics are a therapeutic class of drugs wich aim is to mimic adrenaline and noradrenaline, contained in many over-the-counter medications such as “Humex Cold”. To date, 32 cases of delayed hypersensitivity induced by pseudoephedrine have been reported in the literature ranging from MPE to severe cutaneous adverse drug reactions, including 3 PEAG and 4 EMP. Cross-reactivities within sympathomimetics are not yet well established. We describe here two case reports of delayed cutaneous drug reactions to sympathomimetics, one maculo-papular exanthema and one acute generalized exanthematic pustulosis. We evaluated cross-reactivity and review the sympathomimetic drugs to be able to make a summary table. We first did patch tests with the molecule that caused the initial skin reaction. Then, searching for cross-reaction: we tested with patch tests thirteen sumpathomimetics with different properties. We also performed skin biopsies on positive patch tests for histological analysis in RNA later for the patient who presented acute generalized exanthematic pustulosis. Patient who did maculopapular exanthema had a negative patch test to pseudoephedrine after two series of allergological tests but did a recurrence of maculo-papular exanthema after oral provocation to pseudoephedrine and with an emergency treatment with ephedrine. A new allergological workup revealed a positive ephedrine patch test at 72 h. The search for cross-reactivity had highlighted during a 3rd exploration positive patch tests at 72 h for: ephedrine, pseudoephedrine in three different molecules (Humex, Actifed, Rhinadvil) anda positive patch test to phenylephrine. Patient who did an acute generalized exanthematic pustulosis had a positive pseudephedrine patch test. No cross-reactivity with other sympathomimetics was found. Literature is weak regarding cases of delayed cross-hypersensitivity to sympathomimetics even if searching for cross-allergies seems to be necessary. We propose summary table and a list of of sympathomimetic drug to test when faced to a delayed cutaneous drug reaction.

Drug Eruptions with Cases: Fixed Drug Eruption and DRESS Syndrome

Cutaneous drug reactions usually occur with mild and self-limiting lesions, but severe forms can be life-threatening. Non-steroidal anti-inflammatory drugs, antibiotics, and anticonvulsants often cause drug reactions. Herein, we presented two cases of immunological drug reaction, one with mild and localized fixed drug eruption and the other with more severe and diffuse DRESS syndrome.

Severe blistering eruptions induced by immune checkpoint inhibitors: a multicentre international study of 32 cases.

Among dermatologic adverse events induced by immune checkpoint inhibitors (ICI), bullous life-threatening reactions are rare. To better define the clinical and histological features, treatment, and prognosis of ICI-related severe blistering cutaneous eruptions. This retrospective case series was conducted between 2014/05/15 and 2021/04/15 by the dermatology departments of four international registries involved in drug reactions. Inclusion criteria were age ≥18 years old, skin eruption with blisters with detachment covering ≥1% body surface area and at least one mucous membrane involved, available pictures, and ICI as suspect drug. Autoimmune bullous disorders were excluded. Each participant medical team gave his own diagnosis conclusion: epidermal necrolysis (EN), severe lichenoid dermatosis (LD), or unclassified dermatosis (UD). After a standardized review of pictures, cases were reclassified by four experts in EN or LD/UD. Skin biopsies were blindly reviewed. Thirty-two patients were included. Median time to onset was 52 days (3-420 days). Cases were originally diagnosed as EN in 21 cases and LD/UD in 11 cases. After review by experts, 10/21 EN were reclassified as LD/UD. The following manifestations were more frequent or severe in EN: fever, purpuric macules, blisters, ocular involvement, and maximal detachment. Most patients were treated with topical with or without systemic corticosteroids. Eight patients (25%) died in the acute phase. The culprit ICI was not resumed in 92% of cases. In three patients, another ICI was given with a good tolerance. Histology did not reveal significant differences between groups. Severe blistering cutaneous drug reactions induced by ICI are often overdiagnosed as EN. Consensus for management is pending.

A CLINICO-ETIOLOGICAL STUDY OF ADVERSE CUTANEOUS DRUG REACTIONS AT TERTIARY CARE CENTER IN SOUTH INDIA

Objective: The objective of the study was to study the most common aetiology, different clinical manifestations of adverse cutaneous drug reactions (ACDR), and to assess the association of morphological cutaneous pattern of ACDR and etiological group of drugs. Methods: A cross-sectional, observational study was carried out at dermatological department of a large tertiary care center in Southern India. All clinically suspected ACDRs due to allopathic drugs, presented during two year period of all age groups and both sex were included in the study. A written informed consent was taken from patients and data were collected by means of pre-tested Performa including detailed clinical history, examination and relevant laboratory investigations. SPSS (Version 23.0) was used to obtain the results. Results: About 46% were between age group of 19–40 years. Majority were female (54%). 59% had generalized lesions, 98% had cutaneous manifestations, and 30% had mucous involvement. Itching was the most common presenting feature (48%). However, only 6% patients were asymptomatic. Most common etiological group of drugs responsible for ACDRs are antibiotics (27%) and NSAIDs (19%) pointing toward its rampant use with and without prescription. Among the Antibiotics, Ciprofloxacin was noted to be the most common responsible for ACDR. Diclofenac was found be the most common NSAID followed by Ibuprofen and Ketorolac. Majority of ACDRs, that is, 72% comprised of probable ACDRsas per “Naranjo’s algorithm.” The most common type of lesions observed was plaques (29%), macules (19%), papules (6%), and edema (6%). A predominant pattern of correlation was noted between antibiotics and erythematous drug eruption, SJS, vasculitis, erythroderma, and AGEP. The most common clinical pattern of ACDR observed was Urticaria (19%), Fixed Drug Eruption (13%), Erythema Multiforme (9%), and Lichenoid drug eruption (8%). Conclusion: The significance of this study was to study the profile of ACDR and to emphasize the awareness to the health-care providers on vigilant monitoring of ADRs and promptly reporting the same to prevent the occurrence of reactions in the vulnerable population. A systemic comprehensive monitoring and documentation of ADRs can curtail many untoward reactions in patient care and will lead to an effective drug administration. More studies are essential to create awareness of possible ACDR and to assist in the early recognition which, in turn, aids in the implementation of effective drug safety measures.

Dermatology consultation requests from a university hospital's pediatric and adult emergency departments: A 5-year retrospective analysis.

Unnecessary dermatology consultation requests from emergency departments (EDs) are a common occurrence worldwide. This study aimed to analyze the demographic and clinical characteristics of patients consulted to the dermatology department for dermatologic disorders by a university hospital's pediatric ED (PED) and adult ED (AED). The electronic medical records of 2316 dermatology consultation requests from the PED and AED during a 5-year period were retrospectively reviewed. Patient demographic and clinical characteristics, dermatological diagnoses, and time of day of dermatology consultation requests from the PED and AED were retrospectively analyzed. The electronic medical records of 1845 consultation requests with complete data were included in the study. There were 969 (52.5%) consultation requests from the PED and 876 (47.5%) from the AED. Mean time from onset of dermatological symptoms to ED presentation was 31.6 d. Herpes zoster infections (18.5%), adverse cutaneous drug reactions (8.1%), and urticaria with angioedema (7.9%) were the most common skin disorders resulting in consultation requests from the AED, versus non-specific viral infections (9.2%), insect bites (8.3%), and atopic dermatitis (8.2%) from the PED. In all, 11.5% of ED patients that received dermatology department consultation required hospitalization due to dermatologic disorders. As patients commonly present to EDs with non-urgent dermatological diseases, ED physicians should receive training on common dermatological diseases so as to decrease the number of unnecessary dermatology consultation requests.

Clinicoepidemiological study of fixed drug eruption in tertiary care hospital

Background: Adverse cutaneous drug reactions pose diagnostic difficulties due to a varied clinical manifestations and broad categories of causative agents. Fixed drug eruptions (FDE) are one of them. Present study aims i) to record various clinical features of FDE, their causative agents and ii) to study the pattern of morbidity in patients with FDE in a tertiary care hospital, Rajkot, Gujarat, India.Methods: The 88 patients with FDEs attending department of dermatology, venereology and leprosy at PDU govt. medical college and hospital, Rajkot, Gujarat from September 2018 to September 2020 were included after informed consent. After taking thorough history, complete blood count and biochemical tests were done. HIV testing was done in severe reactions with generalised involvement. Appropriate treatment was given with counselling regarding the offending drug for prevention of reaction in future.Results: The male patients were more affected than female patients with M: F ratio of 1.3:1. The most common age group affected was 21-30 years (22.7%). Antimicrobials were the most common offending drugs (43.2%). None of the patients were HIV reactive in our study. No mortality was reported in our study.Conclusions: The patterns of FDE and the causative drugs are remarkably different in our study. Knowledge of patterns and the causative agents helps in prevention of same reactions in future in patients.

Common treatment diagnoses in dermatological emergency services

Patients with avariety of dermatologic conditions, ranging from mild to life-threatening course of disease, present to the dermatological emergency service. The article provides an overview of prevalent conditions and recommendations for diagnosis and treatment according to guidelines. Major acute allergic diseases such as anaphylaxis, urticaria, angioedema and cutaneous drug reactions are discussed. In the field of infectious skin diseases, herpes zoster and erysipelas are common reasons for dermatological consultation. In recent years, scabies has reemerged. Educating patients properly about scabies management can prevent further treatment failures. Finally, the article focuses on sexually transmitted infections including urogenital gonorrhea and chlamydia.

Les Nécrolyses Epidermiques Toxiques (NET) au service de dermatologie du CHU Aristide Le Dantec de Dakar : aspects épidémiologiques, phénotypiques, étiologiques et évolutifs de 2005 à 2019 (15 ans)

ObjectivesTo determine the epidemiological, phenotypic, etiological and evolutionary aspects of NET in the Dermatology department of the HALD. Methodologycross-sectional study with retrospective recruitment over 15years (2005–2019) including all the files of patients hospitalized in the Dermatology department of HALD for NET. Data were collected by Sphinx software and analyzed by SPSS20.0. The associations were assessed using the X2 test. Any P≤0.05 was statistically significant. ResultsWe collected 142 cases of NET (44.4% of cutaneous drug reaction). The mean age was 32.84. There was a significant correlation between the occurrence and age (P=0.0001). These were 80 cases of Lyell syndrome (SL), 41 cases of Steven Johnson syndrome (SJS), and 21 cases of overlap syndrome (SC). The inducing drugs were not identified in 46 cases (32.4%). NETs were induced by anticonvulsants in 19%, antibiotics (Cotrimoxazole) in 10.6%, analgesics (Paracetamol) in 10.6%, anti-gout drugs (Allopurinol) in 7%, antimalarial (Sulfadoxine-pyrimethamine) in 4.9%, anti-inflammatory drugs (Ibuprofen) in 4.2%, ARVs (Nevirapine) in 2.1%. Oral herbal medicine was also incriminated at 7.7%. Death noted in 17.6% of cases was often secondary to septic shock. Death was correlated with age (P=0.002), type of drug eruption (P=0.006) and time to hospitalization (P=0.05). ConclusionNETs are dominated by Lyell syndrome (56.3%). anticonvulsants are the main induced drugs.