title: Adverse cutaneous drug reactions in a single quaternary referral hospital.
abstract: BACKGROUND
  Adverse cutaneous drug reactions are frequent in hospital settings and are responsible for increased morbidity, mortality, and socioeconomic costs. The objective of this study was to identify high risk factors in hospitalized patients with adverse cutaneous drug reactions.
  
  
  METHODS
  This descriptive and retrospective study was performed with data from 117 patients admitted to a quaternary hospital over 44 months. We reviewed their epidemiological data, suspected drugs, clinical presentation, histopathological diagnosis, and outcome. Statistical analysis was performed using the chi-squared test with a significance level of 5%.
  
  
  RESULTS
  Anticonvulsants were responsible for 23.9% of cases followed by antibiotics (22.2%). In 29% of cases, patients were taking multiple medications that could have triggered their reactions. The most common clinical forms were exanthema (37.6%), drug reaction with eosinophilia and systemic symptoms (DRESS) (14.5%), and Stevens-Johnson syndrome/toxic epidermal necrolysis (12.8%). Anticonvulsants were associated with severe forms of adverse drug reactions. Most patients (89.7%) presented clinical improvement after treatment. There was a relationship between the use of anticonvulsants and atypical lymphocytes in the dermal infiltrate, as well as the clinical form DRESS and atypical lymphocytes in the dermal infiltrate.
  
  
  CONCLUSIONS
  The use of anticonvulsants was a high risk factor for severe clinical forms of drug reactions. The presence of atypical lymphocyte infiltrates in the dermis could indicate the use of anticonvulsants.
authors.affiliation: Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Luciane F F
authors.initials: LF
authors.lastname: Botelho
authors.affiliation: Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Adriana M
authors.initials: AM
authors.lastname: Porro
authors.affiliation: Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Milvia M S S
authors.initials: MM
authors.lastname: Enokihara
authors.affiliation: Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Jane
authors.initials: J
authors.lastname: Tomimori
mesh_terms: D056150:Acute Generalized Exanthematous Pustulosis / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D000927:Anticonvulsants / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003873:Dermatitis, Exfoliative / Q000139:chemically induced; D003875:Drug Eruptions / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D063926:Drug Hypersensitivity Syndrome / Q000209:etiology / Q000473:pathology; D004892:Erythema Multiforme / Q000139:chemically induced; D005076:Exanthema / Q000139:chemically induced*; D005260:Female; D060831:Hand-Foot Syndrome / Q000209:etiology; D006761:Hospitals; D006801:Humans; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013262:Stevens-Johnson Syndrome / Q000209:etiology; D014581:Urticaria / Q000139:chemically induced; D014657:Vasculitis / Q000139:chemically induced; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000927:Anticonvulsants