Epidemiology of Severe Cutaneous Adverse Drug Reactions in a Northeastern Region of Thailand
Keywords:
Severe cutaneous adverse drug reactions, Steven-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosisAbstract
Background and Objective: Severe cutaneous adverse reactions (SCARs) are generally unrelated to the mechanism of action of the drug and are associated with significant mortality as well as both short- and long-term morbidity. Epidemiological data on SCARs vary based on regional drug use patterns and health issues. This study aimed to investigate the causative drugs, clinical characteristics, treatment, and outcomes of SCARs in hospitalized patients diagnosed with drug-induced SCARs at a northeastern region of Thailand.
Methods: Patients admitted to Khon Kaen Hospital for SCARs or who developed SCARs during hospitalization for other conditions between 2019 and 2023 were recruited. Drug causality was assessed using the Naranjo algorithm. Demographic and clinical data were reviewed and collected from medical records.
Results: Among 64 patients diagnosed with SCARs, the most common phenotype were SJS (28 patients), followed by DRESS, TEN, SJS/TEN overlap, and AGEP. The average age of SCARs patients was 50.50 ± 18.18 years, with 51.46% being male. Antimicrobial agents (48.43%) were the most common causative drugs, followed by anticonvulsants (23.44%) and allopurinol (18.75%). The average onset of SCARs was 23.59 ± 26.39 days. The average length of hospital stay for SCARs treatment was 10.19 ± 11.23 days. TEN patients had the longest hospital stays and highest cost of treatment. Only one patient with TEN induced by allopurinol died at SCARs episode. Immunomodulating agents, including corticosteroids, cyclosporine A, or IVIg, were beneficial in treatment of SCARs.
Conclusions: This study provides valuable insights into the epidemiological data of SCARs, enhancing clinical practice by promoting awareness, earlier diagnosis, proper management and improved patient safety.
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