Types Of Cutaneous Adverse Drug Reactions Research Articles

Impact of antiretroviral therapy on cutaneous adverse drug reactions in adult HIV patients: A study from a tertiary care hospital

Background: Adverse drug reactions (ADRs) significantly impact public healthcare, especially among HIV patients. These reactions, which range from mild pruritus to severe conditions such as Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), affect the quality of life and treatment outcomes. Aims and Objectives: The current study was designed to evaluate the various types of cutaneous ADRs (CADRs) in adult HIV patients undergoing antiretroviral therapy (ART). Materials and Methods: A retrospective record-based study was conducted at the Department of Dermatology, Venereology, and Leprosy, Government Medical College/Government General Hospital, Suryapet, Telangana, India. Data from November 2017 to October 2020 were analyzed, focusing on patients over 18 years on ART. Relevant demographic and medical data, including blood tests, liver and renal function, and CD4 counts, were collected. Results: Out of 3532 patients on ART, 568 (16.08%) developed CADRs. Females represented 54.2% of these cases. The age group most affected was between 29 and 48 years. The most common ART regimen was Tenofovir+Lamivudin+Dolutegravir, followed by zidovudine-based combinations. Nevirapine-based regimens had a higher association with CADRs, particularly severe reactions such as SJS and TEN. Conclusion: A significant proportion of HIV patients on ART experience CADRs, with certain drug combinations posing higher risks. This study highlights the need for careful monitoring and selection of ART regimens to minimize the risk of severe CADRs, thereby improving patient outcomes and quality of life in HIV treatment.

A study of cutaneous adverse drug reactions in a tertiary care center in south India

Background: Cutaneous adverse drug reactions (CADRs) are common among adverse drug reactions (ADRs). Early identification of ADRs can reduce the morbidity and mortality rates. Objectives: To know the pattern of various types of CADRs and to find out the causative drugs involved. Materials and Methods: Retrospective analysis was performed from ADR register, kept in Dermatology department in a tertiary care center. Naranjo's algorithm was used to determine the causality assessment. Details regarding drug intake, morphology of eruption, offending drugs, history regarding hospitalization, drug rechallenge or drug dose modifications, and treatment given to the patients were assessed. The data were subjected to descriptive analysis. Results: A total of 216 patients were recruited into the study, of which 118 were male and 98 were female. Antimicrobials (30.1%) were noted to be the most common offending drugs, followed by antiepileptics (18.1%), analgesics and antipyretics (11.1%), and anticancer drugs (11.1%). The most common presentation of CADR was maculopapular drug eruption (31.5%), followed by fixed drug eruption (13.4%). Conclusion: Among the antimicrobials, penicillins (13.9%) were the most common cause of CADR, followed by cephalosporins (8.8%) and fluoroquinolones (6.9%). A total of 28 patients (13%) were found to have severe cutaneous adverse reactions to drugs. It is important to closely monitor the patient, when a new drug is introduced, which will aid in detecting and preventing of CADRs.

Histopathological study of six types of adverse cutaneous drug reactions using granulysin expression.

Few studies have been published on the histopathology of cutaneous adverse drug reactions (CADR), and most of these lack information on skin allergological tests. The histopathology of drug reaction with eosinophilia and systemic symptoms (DRESS) is also seldom described. The purpose of our study was to examine six types of well-documented CADR (maculopapular exanthema, DRESS, fixed drug eruption, Stevens-Johnson syndrome, toxic epidermal necrolysis [TEN], and acute generalized exanthematous pustulosis) using histopathology and immunohistochemistry to evaluate the expression of granulysin, a key molecule in TEN. We retrospectively included 106 skin biopsies performed in proven cases of CADR (by chronological investigation, single attributable drug, or/and skin tests). All slides were reviewed, and microscopic changes were analyzed using a standardized form. Granulysin expression was studied by immunohistochemistry. In DRESS, we observed spongiosis, edema, and basal vacuolization, with rare necrotic keratinocytes and constant lymphocytic infiltrate in the superficial dermis. Eosinophils were often present, and pustules were found in 15% of cases. Necrotic keratinocytes are often absent in maculopapular exanthema. Granulysin was expressed in six types of CADR with a trend toward more intense expression in DRESS and TEN. We detailed further about the histopathology of DRESS. Granulysin expression was observed in all CADR with a marked overlap of expression pattern between the six types.