Comparison of Clinico-Epidemiological Features of Cutaneous Adverse Drug Reactions

Author(s): Munnaluri Mohan Rao1 , Kotha Raghupathi Reddy2 , Chittla Sravan3

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. We wanted to compare the clinico-epidemiological features of cutaneous adverse drug reactions in children and adults. METHODS The study sample comprised of two hundred and twenty patients of CADRs over a period of one and a half years. Patients were assessed using the WHO based algorithm of causality assessment of adverse drug reactions. RESULTS 222 rashes were seen in 220 patients and 315 drugs were implicated. The incidence of CADRs among dermatology patients was 10.18 per thousand patients. The incidence of CADRs among adults and children was 10.15 and 10.34 per thousand patients respectively. Out of the two hundred and twenty cases, thirty five (15.9 %) were in the paediatric age group (< 18 years of age). The most common cutaneous adverse drug reaction seen in our patients was maculopapular rash which was seen in 22 % patients. Antimicrobials were found to be the most common cause of CADRs in both adults and children, while drugs acting on the central nervous system were a close second. When rashes were taken individually, antimicrobials were the most common cause of maculopapular reactions, urticaria and toxic epidermal necrolysis in both children and adults. Acneiform eruptions were caused by steroids in 82 % of cases. Although fixed drug eruptions were most commonly caused by antimicrobials in adults (especially quinolones and nitroimidazoles), NSAIDs particularly nimesulide was also implicated in a substantial number of cases. CONCLUSIONS Newer antibiotics like cephalosporins are being used more often and thus a higher number of adverse drug reactions are seen with them. Therefore it would be useful for every individual institution to maintain a drug reaction registry.