Analysis of cutaneous adverse drug reactions in a tertiary care hospital in South Tamil Nadu

Abstract

Background: Cutaneous adverse drug reactions (CADRs) are among the most frequently reported adverse drug reactions (10 to 30%) with overall incidence of 6.2/1000 cases in India and 8% of hospitalisation among Dermatology inpatients. The aim was to analyse the CADRs with reference to its prevalence, causative drugs, morphological patterns, polypharmacy and drug reaction severity by Hartwig’s severity assessment scale.Methods: This study was a retrospective study done in the Department of Dermatology, Venereology and Leprosy (DVL) over a period of 5 years (2015 to 2019) from CADR registers. Mean, standard deviation and chi square test were used for statistical analysis. P≤0.05 was considered as statistically significant.Results: A total of 134 cases of CADRs were encountered which comprised 0.2% (2/1000) of total OP census with equal gender ratio and involved most commonly the younger adults. The drug groups mainly responsible were anticonvulsants (24.7%) followed by non-steroidal anti-inflammatory drugs (NSAIDS) (22.5%), antibiotics (20.9%) followed by antiretrovirals (ART) and antituberculous drugs (ATT). The common morphological patterns were acute exanthem (32.2%), exfoliative dermatitis (14.9%) and toxic epidermal necrolysis (14.2%). Over the counter drugs accounted for 25.6% of cases. Around 38.1% were on polypharmacy. In this study, 15.7% had mild CADR, 53.7% had moderate and 30.6% had severe drug reactions with 2.2% mortality based on the Hartwig’s severity assessment scale. Commonest cause of severe CADRs was anticonvulsants and benign CADRs was NSAIDS.Conclusions: Proper history taking and documentation of data, recollection of sequence of events by the patient and drug re-challenge will help us in deciding the causative drug preventing further occurrence.