EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS, CAUSATIVE DRUGS, AND DIAGNOSTIC CHALLENGES OF FIXED DRUG ERUPTION IN ELDERLY PATIENTS: IS BULLOUS TYPE A MORE COMMON CLINICAL PHENOTYPE?

Öz

Objective: The present study aimed to evaluate the epidemiological and clinical features, causative drugs, and diagnostic challenges of Fixed drug eruption (FDE) in elderly patients. Material and Methods: In this single-center, retrospective, cross-sectional study, we evaluated data of all consecutive adult patients (aged >18 years) with an established diagnosis of FDE between 1996-2018 in our tertiary referral center in Turkey. Elderly patients who were aged ≥60 years at the time of diagnosis were allocated to the study. Results: Among 182 adult FDE patients, 14 (7.7%) patients (male/ female=1/1.8) were in the elderly group (mean age=66.1±6.9 years). Fix drug eruption was induced by intermittently taken drugs in all patients, 50% of whom had polypharmacy (concurrent use of ≥5 medications). Trimethoprim-sulfamethoxazole (42.9%) and non-steroidal anti-inflammatory drugs (35.7%) were the main causative drugs, while ornidazole was a remarkable novel FDE inducer since 2011. Fix drug eruption was mostly located on the trunk and extremities. Mucosal involvement was less frequent. Ten (71.4%) patients had bullous FDE (BFDE). There were no statistically significant differences between the gender and mean ages of the patients with and without BFDE. Conclusion: Our long-term experience demonstrated that FDE may also affect elderly patients. Most of the patients had BFDE raising the question of whether the bullous type is a more common clinical phenotype in these patients. Among the important diagnostic challenges of FDE in this age group, e.g., polypharmacy, multimorbidity, recall problems, cognitive disorders, frailty, and immunosenescence, BFDE should also be kept in mind as it may clinically mimic Stevens-Johnson syndrome/toxic epidermal necrolysis, and autoimmune bullous diseases.

Anahtar Kelimeler

• Drug eruptions
• aged
• vesiculobullous skin diseases
• trimethoprim-sulfamethoxazole drug combination
• non-steroidal anti-inflammatory agents
• ornidazole

YAŞLI HASTALARDA FİKS İLAÇ ERÜPSİYONUNUN EPİDEMİYOLOJİK VE KLİNİK ÖZELLİKLERİ, ETKEN İLAÇLAR VE TANISAL ZORLUKLAR: BÜLLÜ TİP DAHA SIK GÖRÜLEN BİR KLİNİK FENOTİP MİDİR?

Öz

Amaç: Bu çalışmanın amacı, yaşlı hastalarda fiks ilaç erüpsiyonunun (FİE) epidemiyolojik ve klinik özelliklerinin, etken ilaçlarının ve tanısal zorluklarının değerlendirilmesidir. Gereç ve Yöntemler: Tek merkezli, retrospektif kesitsel çalışmamızda, Türkiye’de üçüncü basamak bir referans merkezi Alerji kliniğinde, 1996-2018 yılları arasında FİE tanısı konulmuş olan erişkin hastaların (>18 yaş) dosyaları incelenmiştir. FİE tanısı konulduğu sırada 60 yaş ve üzerinde olan yaşlı hastalar çalışmaya dahil edilmişlerdir. Bulgular: Toplam 182 erişkin FİE hastası arasından, 14 (%7,7) hasta (erkek/kadın=1/1,8) yaşlı grubundaydı (ortalama yaş=66,1±6,9). Fiks ilaç Erüpsiyonu, hastaların tümünde aralıklı olarak kullanılan ilaçlara bağlı gelişmişti. Bu hastaların %50’ sinde polifarmasi (eş zamanlı ≥5 ilaç kullanımı) mevcuttu. Fiks ilaç Erüpsiyonunun en sık etkenleri, trimetoprim-sülfametoksazol (%42,9) ve nonsteroidal antienflamatuvar ilaçlar (%35,7) olmakla birlikte 2011 yılından itibaren ornidazol de yeni ve dikkat çekici bir Fiks ilaç Erüpsiyonu etkeni olarak karşımıza çıkmıştı. Fiks ilaç Erüpsiyonu lezyonları sıklıkla gövde ve ekstremitelerde yerleşmekteydi. Mukozal tutulum daha nadirdi. On (%71,4) hastada büllü FİE (BFİE) saptandı. Büllü FİE olan ve olmayan hastalar arasında cinsiyet ve ortalama yaş açısından istatistiksel olarak anlamlı farklılıklar saptanmadı. Sonuç: Uzun-dönem klinik tecrübemiz ışığında, FİE yaşlı kişilerde de görülebilen ve hastaların büyük bir çoğunluğunda büllü morfolojinin (BFİE) eşlik ettiği bir ilaç döküntüsü olarak karşımıza çıkmıştır. Bu durum, BFİE’nin bu yaş grubunda sık görülen bir klinik fenotip mi olduğu sorusunu akla getirmiştir. BFİE’nin klinik olarak Stevens-Johnson sendromu/toksik epidermal nekroliz veya otoimmün büllü hastalıklar ile ayırıcı tanıya girmesi tanıda zorluklara yol açabilmektedir. Fiks ilaç Erüpsiyonu şüphesi olan yaşlı hastalarda polifarmasi, multimorbidite, hafıza problemleri, kognitif bozukluklar, kırılganlık ve immün sistemin yaşlanması (immunosenescence) gibi tanıyı güçleştirebilecek durumlar arasında BFİE de akla gelmelidir.

Anahtar Kelimeler

• İlaç erüpsiyonları
• yaşlı
• büllü deri hastalıkları
• non-steroidal antienflamatuvar ilaçlar
• trimetoprim-sülfametoksazol
• ornidazol

Kaynakça

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