Morphological Pattern of Cutaneous Adverse Drug Reactions due to Antiepileptic Drugs in Eastern India.
BACKGROUND
Cutaneous manifestations of adverse drug reactions are a common occurrence and need to be differentiated from other causes of similar manifestations. Antiepileptic drugs (AED) usually are responsible for severe cutaneous adverse drug reactions (CADR) like Stevens-Johnson Syndrome/Toxic epidermal necrolysis (SJS/TEN) and drug rash with eosinophillia and systemic symptoms (DRESS). There is paucity of published research regarding morphological pattern of CADR due to various antiepileptic drugs AED.


OBJECTIVE
To study the morphological patterns of CADR due to AED and common anticonvulsant drugs implicated particularly in severe CADR such as SJS/TEN and DRESS in a tertiary care teaching hospital in eastern India.


METHODS
A prospective, observational study was conducted over a period of 4 years from August 2009 to July 2013 after the approval of the Institutional Ethics Committee using self-reporting method for selection of cases.


METHODS
All patients with CADR after AED consumption for various conditions presenting to the Dermatology outpatient department (OPD) and Pediatric OPD and Indoor patients of a tertiary care teaching hospital located in Rohtas district of Bihar were included in this study.


RESULTS
During the study period, 64 cases of severe CADRs were included in this study. Out of 64 patients, 28 were male and 36 were female with mean age 36.1 years (range 6 years to 72 years). Most common AED implicated for CADR was Phenytoin. Maculopapular rash was the most common cutaneous manifestation of ADRs (42.85%). Serious CADR like TEN and SSJS were more likely in patients prescribed Phenytoin and Carbemazepine simultaneously.


CONCLUSIONS
CADRs are a common occurrence and awareness about the same is essential for diagnosis and prevention. This study identified combined use of phenytoin and carbamezepine as a most important risk factor for serious CADR like SJS and TEN.
Associate Professor, Department of Dermatology, Narayan Medical College and Hospital , Jamuhar, Sasaram, Bihar, India .
Punit Kumar
PK
Singh
Associate Professor, Department of Pediatrics, Narayan Medical College and Hospital , Jamuhar, Sasaram, Bihar, India .
Mani Kant
MK
Kumar
Assistant Professor, Department of Dermatology, Narayan Medical College and Hospital , Jamuhar, Sasaram, Bihar, India .
Dharmendra
D
Kumar
Assistant Professor, Department of Pediatrics, Narayan Medical College and Hospital , Jamuhar, Sasaram, Bihar, India .
Prashant
P
Kumar
Maculopapular rash; Stevens-Johnson Syndrome/Toxic epidermal necrolysis