Abstract
Aims: To study the clinicoepidemiological profile of drug eruptions secondary to anticonvulsants among indoor patients in a tertiary care center.
Methods: There were 31 patients with anticonvulsants induced cutaneous adverse reactions who were included from January 2015 to December 2017. Demographic characteristics of the patients, suspected drug, duration between drug intake and onset of reaction, medical history, physical examination and laboratory parameters were recorded.
Results: The mean age group of patients was 44.5 years with the male to female ratio of 2.1: 1. Interval between the drug intake and drug rash was a mean of 39.4 days. Most common presentation was maculopapular rash seen in 21 patients (67.7%) followed by Steven Johnson Syndrome/Toxic Epidermal Necrolysis. The most common offending drug was phenytoin in 23 patients followed by carbamazepine in 5. Abnormal eosinophil counts were seen in 12 patients (38.7%). Liver function abnormalities were seen in 10 patients (32.3 %).
Conclusion: Allergic drug rash to anticonvulsants is common. Phenytoin was the commonest cause. The commonest indication of using phenytoin was as a prophylactic agent in head injury.
Keywords: Adverse drug reactions, anti epileptics, maculopapular.
References
- Arul mani R, Rajendran AD, Suresh B. Adverse drug reaction monitoring in secondary care hospital in south India. Br J ClinPharmacol.2007;65:210–16.
- Kaur S, Kumar B, Ravikiran TN, et al. A study of cutaneous drug reactions. Bull PGI. 1980; 14: 73-9.
- Mani MZ, Mathew M. Study of 218 drug eruptions. Indian J DermatolVenereolLeprol 1983; 49: 109-17.
- Levantine A, Almeyda J. Drug reactions XX: Cutaneous reactions to anticonvulsants. Br J Dermatol. 1972; 87:646-9.
- Fricke-Galindo I, Jung-Cook H, Lerena AL, López-López M. Pharmacogenetics of adverse reactions to antiepileptic drugs. Neurología. 2018; 33:165-76
- Sharma R, Dogra D, Dogra N. A study of cutaneous adverse drug reactions at a tertiary centre in Jammu, India. Indian Dermatol Online J. 2015;6:168-71. http://www.idoj.in/text.asp?2015/6/3/168/156384
- Suther JV, Desai SV. A study of adverse cutaneous drug reactions in outdoor patients attending to Skin and V.D. Department of Shree Krishna Hospital, Karamsad. Int J Res Pharm Biomed Sci. 2011;2:2229-3701.
- Patel RM, Marfatia YS. Clinical study of cutaneous drug eruptions in 200 patients. Indian J Dermatol Venereol Leprol. 2008;74 (4): 430-6. http://www.ijdvl.com/text.asp? 2008/74/4/430/42883
- Vatve M, Sharma VK, Sawhney IMS, Kumar B. Evaluation of Patch tests in identification of causative agent in drug rashes due to antiepileptics. Indian J Dermatol Venerol Leprol 2001; 67: 317-9.
- Sudharani C, Udayakumar B, Geetakiran A. Adverse cutaneous drug reactions to anticonvulsants – a study at a tertiary care center in telangana. J Dental and Medical Sciences. 2016; 15(2): 11-5.DOI: 10.9790/0853-15251115
- Wang X, Lang S, Shi X, Tian H, Wang R, Yang F. Antiepileptic drug-induced skin reactions: A retrospective study and analysis in 3793 Chinese patients with epilepsy. Clinical Neurology and Neurosurgery. 2012; 114 : 862–865. doi:10.1016/j.clineuro.2012.01.019
- Nadimpalli SKKV, Badabagni P, Dasika S, Bendapudi RV. A study of cutaneous adverse drug eruptions in dermatological practice. Indian J Clin Exp Dermatol. 2016; 2(3): 79-83.
- Balachandran C, Shenoi SP, Sarkar D et al. Patch tests in adverse drug interaction. Indian J Dermatol Venereol Leprol. 2002; 68:13-5.
- Karimzadeh P, Bakrani V. Antiepileptic Drug-Related Adverse Reactions and Factors Influencing These Reactions. Iran J Child Neurol. 2013 Summer; 7(3): 23-7.
- Feliciani C,Verrotti G, Coscione G, Toto P, Morelli F, Benedetto AD, Salladini C, Chiarelli F, Tulli A. Skin reactions due to antiepileptic drugs: Several case-reports with long term follow-up. 2002; 16(1): 89-93.
- Vora R, Diwan N, Jivani N, Singhal R. A study of adverse cutaneous drug reactions (ACDR)owing to antiepileptics at a rural-based tertiary-carecenter, Gujarat. Natl J Physiol Pharm Pharmacol. 2016;6(2): 140-45.
- Malekafzali B, Najibi F. Cutaneous reactions of anticonvulsantdrugs. JDC. 2011;2(1):30–4.
- Romagosa R, Kapoor S, Sanders J, Berman B. Inpatient adverse cutaneous drug eruptions and eosinophilia. Arch Dermatol. 2001;137:511-2. https://www.ncbi.nlm.nih.gov/pubmed/11295947
- Sharma VK, Vatve M, Sawhney IM, Kumar B. Clinical spectrum of drug rashes due to antiepileptics. J Assoc Physicians India. 1998; 46(7): 595-7.
- Patel TK, Thakkar SH, Sharma DC. Cutaneous adverse drug reactions in Indian population: A systematic review. Indian Dermatol Online J. 2014; 5 (2): 76-S86.
- Temkin NR, Dikmen SS, Wilensky AJ, Keihm J, Chabal S,Winn HR. A randomized, Double-blind study of phenytoin for the prevention of post – traumatic seizures. N Engl J Med. 1990; 323: 497-502.
Corresponding Author
Dr Mudita Gupta
Assistant Professor, Department of Dermatology, IGMC, Shimla, India