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

Yıl 2021, Cilt 84, Sayı 4, 559 - 567, 01.10.2021
https://doi.org/10.26650/IUITFD.2021.934957

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.

Kaynakça

  • 1. World Health Organization (2011). Global Health and Aging. Available from: URL: https://www.who.int/ageing/ publications/global_health.pdf
  • 2. United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Ageing 2019: Highlights. (ST/ESA/SER.A/430). Available from: URL: https://www.un.org/en/development/desa/population/ publications/pdf/ageing/WorldPopulationAgeing2019- Highlights.pdf
  • 3. United Nations, Department of Economic and Social Affairs, Population Division (2013). World Population Ageing 2013. (ST/ESA/SER.A/348.). Available from: URL: https://www. un.org/en/development/desa/population/publications/ pdf/ageing/WorldPopulationAgeing2013.pdf
  • 4. Heng YK, Lim YL. Cutaneous adverse drug reactions in the elderly. Curr Opin Allergy Clin Immunol 2015;15(4):300-7. [CrossRef]
  • 5. Davies EA, O’Mahony MS. Adverse drug reactions in special populations - the elderly. Br J Clin Pharmacol 2015;80(4):796-807. [CrossRef]
  • 6. Carneiro SC, Azevedo-e-Silva MC, Ramos-e-Silva M. Drug eruptions in the elderly. Clin Dermatol 2011;29(1):43-8. [CrossRef] 7. Özkaya E. Fixed drug eruption: state of the art. J Dtsch Dermatol Ges 2008;6(3):181-8. [CrossRef]
  • 8. Patel S, John AM, Handler MZ, Schwartz RA. Fixed drug eruptions: an update, emphasizing the potentially lethal generalized bullous fixed drug eruption. Am J Clin Dermatol 2020;21(3):393-9. [CrossRef]
  • 9. Özkaya E. Changing trends in inducer drugs of fixed drug eruption: a 20-year cross-sectional study from Turkey. J Dtsch Dermatol Ges 2018;16(4):474-6. [CrossRef]
  • 10. Ngwasiri CA, Abanda MH, Aminde LN. Ivermectin-induced fixed drug eruption in an elderly Cameroonian: a case report. J Med Case Rep 2018;12(1):254. [CrossRef]
  • 11. Byrd RC, Mournighan KJ, Baca-Atlas M, Helton MR, Sun NZ, Siegel MB. Generalized bullous fixed-drug eruption secondary to the influenza vaccine. JAAD Case Rep 2018;4(9):953-5. [CrossRef]
  • 12. Paulmann M, Mockenhaupt M. Unfreiwillige Reexposition: Generalisiertes bullöses fixes Arzneiexanthem bei 2 älteren Patientinnen [Unintended rechallenge : Generalized bullous fixed drug eruption in two elderly women]. Hautarzt 2017;68(1):59-63. [CrossRef]
  • 13. Ozkaya-Bayazit E, Akar U. Fixed drug eruption induced by trimethoprim-sulfamethoxazole: evidence for a link to HLA-A30 B13 Cw6 haplotype. J Am Acad Dermatol 2001;45(5):712-7. [CrossRef]
  • 14. Cho YT, Lin JW, Chen YC, Chang CY, Hsiao CH, Chung WH, et al. Generalized bullous fixed drug eruption is distinct from Stevens-Johnson syndrome/toxic epidermal necrolysis by immunohistopathological features. J Am Acad Dermatol 2014;70(3):539-48. [CrossRef]
  • 15. Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J. A comprehensive review of non-steroidal anti-inflammatory drug use in the elderly. Aging Dis 2018;9(1):143-150. [CrossRef]
  • 16. Vandraas KF, Spigset O, Mahic M, Slørdal L. Non-steroidal anti-inflammatory drugs: use and co-treatment with potentially interacting medications in the elderly. Eur J Clin Pharmacol 2010;66(8):823-9. [CrossRef]
  • 17. Gupta S, Jain VK, Aggarwal K, Gupta S, Mahendra A. Fixed drug eruption caused by ornidazole. Contact Dermatitis 2005;53(5):300-1. [CrossRef]
  • 18. Gupta S, Mahendra A, Gupta S, Kaur S. Multiple fixed drug eruption caused by ornidazole. Dermatitis 2010;21(6):330-3. [CrossRef]
  • 19. Sanmukhani J, Shah V, Baxi S, Tripathi C. Fixed drug eruption with ornidazole having cross-sensitivity to secnidazole but not to other nitro-imidazole compounds: a case report. Br J Clin Pharmacol 2010;69(6):703-4. [CrossRef]
  • 20. Marya CM, Sharma G, Parashar VP, Dahiya V. Mucosal fixed drug eruption in a patient treated with ornidazole. J Dermatol Case Rep 2012;6(1):21-4. [CrossRef] 21. Gupta R. Fixed drug eruption due to ornidazole. Indian J Dermatol 2014;59(6):635. [CrossRef]
  • 22. Emre S, Ahsen H, Aktaş A. Ornidazole-induced fixed drug reaction on sole: case report and review of the literature. Cutan Ocul Toxicol 2017;36(3):294-6. [CrossRef]
  • 23. World Health Organization (2019). Medication Safety in Polypharmacy. (WHO/UHC/SDS/2019.11). Available from: URL: https://apps.who.int/iris/bitstream/handle/10665/325454/ WHO-UHC-SDS-2019.11-eng.pdf?ua=1
  • 24. Pazan F, Wehling M. Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences. Eur Geriatr Med 2021 Mar 10. [CrossRef]
  • 25. Ozkaya-Bayazit E. Specific site involvement in fixed drug eruption. J Am Acad Dermatol 2003;49(6):1003-7. [CrossRef]
  • 26. Özkaya E. Oral mucosal fixed drug eruption: characteristics and differential diagnosis. J Am Acad Dermatol 2013;69(2):e51-8. [CrossRef]
  • 27. Fourzali KM, Yosipovitch G. Management of itch in the elderly: a review. Dermatol Ther (Heidelb) 2019;9(4):639-53. [CrossRef]
  • 28. Zaouak A, Ben Salem F, Ben Jannet S, Hammami H, Fenniche S. Bullous fixed drug eruption: A potential diagnostic pitfall: a study of 18 cases. Therapie 2019;74(5):527-30. [CrossRef]
  • 29. Ben Fadhel N, Chaabane A, Ammar H, Ben Romdhane H, Soua Y, Chadli Z, et al. Clinical features, culprit drugs, and allergology workup in 41 cases of fixed drug eruption. Contact Dermatitis 2019;81(5):336-40. [CrossRef]
  • 30. Pai VV, Kikkeri NN, Athanikar SB, Shukla P, Bhandari P, Rai V. Retrospective analysis of fixed drug eruptions among patients attending a tertiary care center in Southern India. Indian J Dermatol Venereol Leprol 2014;80(2):194. [CrossRef]
  • 31. Jung JW, Cho SH, Kim KH, Min KU, Kang HR. Clinical features of fixed drug eruption at a tertiary hospital in Korea. Allergy Asthma Immunol Res 2014;6(5):415-20. [CrossRef]
  • 32. Brahimi N, Routier E, Raison-Peyron N, Tronquoy AF, Pouget-Jasson C, Amarger S, et al. A three-year-analysis of fixed drug eruptions in hospital settings in France. Eur J Dermatol 2010;20(4):461-4. [CrossRef]
  • 33. Cho YT, Lin JW, Chen YC, Chang CY, Hsiao CH, Chung WH, et al. Generalized bullous fixed drug eruption is distinct from Stevens-Johnson syndrome/toxic epidermal necrolysis by immunohistopathological features. J Am Acad Dermatol 2014;70(3):539-48. [CrossRef]
  • 34. Weiskopf D, Weinberger B, Grubeck-Loebenstein B. The aging of the immune system. Transpl Int 2009;22(11):1041- 50. [CrossRef]
  • 35. Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez J, et al. European Network for Drug Allergy (ENDA); EAACI interest group on drug hypersensitivity. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy 2003;58(9):854-63. [CrossRef]
  • 36. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet 2013;381(9868):752-62. [CrossRef] 37. Cesari M, Calvani R, Marzetti E. Frailty in older persons. Clin Geriatr Med 2017;33(3):293-303. [CrossRef]

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

Yıl 2021, Cilt 84, Sayı 4, 559 - 567, 01.10.2021
https://doi.org/10.26650/IUITFD.2021.934957

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.

Kaynakça

  • 1. World Health Organization (2011). Global Health and Aging. Available from: URL: https://www.who.int/ageing/ publications/global_health.pdf
  • 2. United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Ageing 2019: Highlights. (ST/ESA/SER.A/430). Available from: URL: https://www.un.org/en/development/desa/population/ publications/pdf/ageing/WorldPopulationAgeing2019- Highlights.pdf
  • 3. United Nations, Department of Economic and Social Affairs, Population Division (2013). World Population Ageing 2013. (ST/ESA/SER.A/348.). Available from: URL: https://www. un.org/en/development/desa/population/publications/ pdf/ageing/WorldPopulationAgeing2013.pdf
  • 4. Heng YK, Lim YL. Cutaneous adverse drug reactions in the elderly. Curr Opin Allergy Clin Immunol 2015;15(4):300-7. [CrossRef]
  • 5. Davies EA, O’Mahony MS. Adverse drug reactions in special populations - the elderly. Br J Clin Pharmacol 2015;80(4):796-807. [CrossRef]
  • 6. Carneiro SC, Azevedo-e-Silva MC, Ramos-e-Silva M. Drug eruptions in the elderly. Clin Dermatol 2011;29(1):43-8. [CrossRef] 7. Özkaya E. Fixed drug eruption: state of the art. J Dtsch Dermatol Ges 2008;6(3):181-8. [CrossRef]
  • 8. Patel S, John AM, Handler MZ, Schwartz RA. Fixed drug eruptions: an update, emphasizing the potentially lethal generalized bullous fixed drug eruption. Am J Clin Dermatol 2020;21(3):393-9. [CrossRef]
  • 9. Özkaya E. Changing trends in inducer drugs of fixed drug eruption: a 20-year cross-sectional study from Turkey. J Dtsch Dermatol Ges 2018;16(4):474-6. [CrossRef]
  • 10. Ngwasiri CA, Abanda MH, Aminde LN. Ivermectin-induced fixed drug eruption in an elderly Cameroonian: a case report. J Med Case Rep 2018;12(1):254. [CrossRef]
  • 11. Byrd RC, Mournighan KJ, Baca-Atlas M, Helton MR, Sun NZ, Siegel MB. Generalized bullous fixed-drug eruption secondary to the influenza vaccine. JAAD Case Rep 2018;4(9):953-5. [CrossRef]
  • 12. Paulmann M, Mockenhaupt M. Unfreiwillige Reexposition: Generalisiertes bullöses fixes Arzneiexanthem bei 2 älteren Patientinnen [Unintended rechallenge : Generalized bullous fixed drug eruption in two elderly women]. Hautarzt 2017;68(1):59-63. [CrossRef]
  • 13. Ozkaya-Bayazit E, Akar U. Fixed drug eruption induced by trimethoprim-sulfamethoxazole: evidence for a link to HLA-A30 B13 Cw6 haplotype. J Am Acad Dermatol 2001;45(5):712-7. [CrossRef]
  • 14. Cho YT, Lin JW, Chen YC, Chang CY, Hsiao CH, Chung WH, et al. Generalized bullous fixed drug eruption is distinct from Stevens-Johnson syndrome/toxic epidermal necrolysis by immunohistopathological features. J Am Acad Dermatol 2014;70(3):539-48. [CrossRef]
  • 15. Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J. A comprehensive review of non-steroidal anti-inflammatory drug use in the elderly. Aging Dis 2018;9(1):143-150. [CrossRef]
  • 16. Vandraas KF, Spigset O, Mahic M, Slørdal L. Non-steroidal anti-inflammatory drugs: use and co-treatment with potentially interacting medications in the elderly. Eur J Clin Pharmacol 2010;66(8):823-9. [CrossRef]
  • 17. Gupta S, Jain VK, Aggarwal K, Gupta S, Mahendra A. Fixed drug eruption caused by ornidazole. Contact Dermatitis 2005;53(5):300-1. [CrossRef]
  • 18. Gupta S, Mahendra A, Gupta S, Kaur S. Multiple fixed drug eruption caused by ornidazole. Dermatitis 2010;21(6):330-3. [CrossRef]
  • 19. Sanmukhani J, Shah V, Baxi S, Tripathi C. Fixed drug eruption with ornidazole having cross-sensitivity to secnidazole but not to other nitro-imidazole compounds: a case report. Br J Clin Pharmacol 2010;69(6):703-4. [CrossRef]
  • 20. Marya CM, Sharma G, Parashar VP, Dahiya V. Mucosal fixed drug eruption in a patient treated with ornidazole. J Dermatol Case Rep 2012;6(1):21-4. [CrossRef] 21. Gupta R. Fixed drug eruption due to ornidazole. Indian J Dermatol 2014;59(6):635. [CrossRef]
  • 22. Emre S, Ahsen H, Aktaş A. Ornidazole-induced fixed drug reaction on sole: case report and review of the literature. Cutan Ocul Toxicol 2017;36(3):294-6. [CrossRef]
  • 23. World Health Organization (2019). Medication Safety in Polypharmacy. (WHO/UHC/SDS/2019.11). Available from: URL: https://apps.who.int/iris/bitstream/handle/10665/325454/ WHO-UHC-SDS-2019.11-eng.pdf?ua=1
  • 24. Pazan F, Wehling M. Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences. Eur Geriatr Med 2021 Mar 10. [CrossRef]
  • 25. Ozkaya-Bayazit E. Specific site involvement in fixed drug eruption. J Am Acad Dermatol 2003;49(6):1003-7. [CrossRef]
  • 26. Özkaya E. Oral mucosal fixed drug eruption: characteristics and differential diagnosis. J Am Acad Dermatol 2013;69(2):e51-8. [CrossRef]
  • 27. Fourzali KM, Yosipovitch G. Management of itch in the elderly: a review. Dermatol Ther (Heidelb) 2019;9(4):639-53. [CrossRef]
  • 28. Zaouak A, Ben Salem F, Ben Jannet S, Hammami H, Fenniche S. Bullous fixed drug eruption: A potential diagnostic pitfall: a study of 18 cases. Therapie 2019;74(5):527-30. [CrossRef]
  • 29. Ben Fadhel N, Chaabane A, Ammar H, Ben Romdhane H, Soua Y, Chadli Z, et al. Clinical features, culprit drugs, and allergology workup in 41 cases of fixed drug eruption. Contact Dermatitis 2019;81(5):336-40. [CrossRef]
  • 30. Pai VV, Kikkeri NN, Athanikar SB, Shukla P, Bhandari P, Rai V. Retrospective analysis of fixed drug eruptions among patients attending a tertiary care center in Southern India. Indian J Dermatol Venereol Leprol 2014;80(2):194. [CrossRef]
  • 31. Jung JW, Cho SH, Kim KH, Min KU, Kang HR. Clinical features of fixed drug eruption at a tertiary hospital in Korea. Allergy Asthma Immunol Res 2014;6(5):415-20. [CrossRef]
  • 32. Brahimi N, Routier E, Raison-Peyron N, Tronquoy AF, Pouget-Jasson C, Amarger S, et al. A three-year-analysis of fixed drug eruptions in hospital settings in France. Eur J Dermatol 2010;20(4):461-4. [CrossRef]
  • 33. Cho YT, Lin JW, Chen YC, Chang CY, Hsiao CH, Chung WH, et al. Generalized bullous fixed drug eruption is distinct from Stevens-Johnson syndrome/toxic epidermal necrolysis by immunohistopathological features. J Am Acad Dermatol 2014;70(3):539-48. [CrossRef]
  • 34. Weiskopf D, Weinberger B, Grubeck-Loebenstein B. The aging of the immune system. Transpl Int 2009;22(11):1041- 50. [CrossRef]
  • 35. Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez J, et al. European Network for Drug Allergy (ENDA); EAACI interest group on drug hypersensitivity. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy 2003;58(9):854-63. [CrossRef]
  • 36. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet 2013;381(9868):752-62. [CrossRef] 37. Cesari M, Calvani R, Marzetti E. Frailty in older persons. Clin Geriatr Med 2017;33(3):293-303. [CrossRef]

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm ARAŞTIRMA
Yazarlar

Goncagül BABUNA KOBANER
ISTANBUL UNIVERSITY, İSTANBUL FACULTY OF MEDICINE, İSTANBUL MEDICINE PR.
0000-0002-0985-5027
Türkiye


Esen ÖZKAYA (Sorumlu Yazar)
ISTANBUL UNIVERSITY, İSTANBUL FACULTY OF MEDICINE, İSTANBUL MEDICINE PR.
0000-0002-9585-9509
Türkiye

Yayımlanma Tarihi 1 Ekim 2021
Yayınlandığı Sayı Yıl 2021, Cilt 84, Sayı 4

Kaynak Göster

Bibtex @araştırma makalesi { iuitfd934957, journal = {Journal of Istanbul Faculty of Medicine}, issn = {}, eissn = {1305-6441}, address = {}, publisher = {İstanbul Üniversitesi}, year = {2021}, volume = {84}, pages = {559 - 567}, doi = {10.26650/IUITFD.2021.934957}, title = {EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS, CAUSATIVE DRUGS, AND DIAGNOSTIC CHALLENGES OF FIXED DRUG ERUPTION IN ELDERLY PATIENTS: IS BULLOUS TYPE A MORE COMMON CLINICAL PHENOTYPE?}, key = {cite}, author = {Babuna Kobaner, Goncagül and Özkaya, Esen} }
APA Babuna Kobaner, G. & Özkaya, E. (2021). EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS, CAUSATIVE DRUGS, AND DIAGNOSTIC CHALLENGES OF FIXED DRUG ERUPTION IN ELDERLY PATIENTS: IS BULLOUS TYPE A MORE COMMON CLINICAL PHENOTYPE? . Journal of Istanbul Faculty of Medicine , 84 (4) , 559-567 . DOI: 10.26650/IUITFD.2021.934957
MLA Babuna Kobaner, G. , Özkaya, E. "EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS, CAUSATIVE DRUGS, AND DIAGNOSTIC CHALLENGES OF FIXED DRUG ERUPTION IN ELDERLY PATIENTS: IS BULLOUS TYPE A MORE COMMON CLINICAL PHENOTYPE?" . Journal of Istanbul Faculty of Medicine 84 (2021 ): 559-567 <https://dergipark.org.tr/tr/pub/iuitfd/issue/64658/934957>
Chicago Babuna Kobaner, G. , Özkaya, E. "EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS, CAUSATIVE DRUGS, AND DIAGNOSTIC CHALLENGES OF FIXED DRUG ERUPTION IN ELDERLY PATIENTS: IS BULLOUS TYPE A MORE COMMON CLINICAL PHENOTYPE?". Journal of Istanbul Faculty of Medicine 84 (2021 ): 559-567
RIS TY - JOUR T1 - EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS, CAUSATIVE DRUGS, AND DIAGNOSTIC CHALLENGES OF FIXED DRUG ERUPTION IN ELDERLY PATIENTS: IS BULLOUS TYPE A MORE COMMON CLINICAL PHENOTYPE? AU - Goncagül Babuna Kobaner , Esen Özkaya Y1 - 2021 PY - 2021 N1 - doi: 10.26650/IUITFD.2021.934957 DO - 10.26650/IUITFD.2021.934957 T2 - Journal of Istanbul Faculty of Medicine JF - Journal JO - JOR SP - 559 EP - 567 VL - 84 IS - 4 SN - -1305-6441 M3 - doi: 10.26650/IUITFD.2021.934957 UR - https://doi.org/10.26650/IUITFD.2021.934957 Y2 - 2021 ER -
EndNote %0 İstanbul Tıp Fakültesi Dergisi EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS, CAUSATIVE DRUGS, AND DIAGNOSTIC CHALLENGES OF FIXED DRUG ERUPTION IN ELDERLY PATIENTS: IS BULLOUS TYPE A MORE COMMON CLINICAL PHENOTYPE? %A Goncagül Babuna Kobaner , Esen Özkaya %T EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS, CAUSATIVE DRUGS, AND DIAGNOSTIC CHALLENGES OF FIXED DRUG ERUPTION IN ELDERLY PATIENTS: IS BULLOUS TYPE A MORE COMMON CLINICAL PHENOTYPE? %D 2021 %J Journal of Istanbul Faculty of Medicine %P -1305-6441 %V 84 %N 4 %R doi: 10.26650/IUITFD.2021.934957 %U 10.26650/IUITFD.2021.934957
ISNAD Babuna Kobaner, Goncagül , Özkaya, Esen . "EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS, CAUSATIVE DRUGS, AND DIAGNOSTIC CHALLENGES OF FIXED DRUG ERUPTION IN ELDERLY PATIENTS: IS BULLOUS TYPE A MORE COMMON CLINICAL PHENOTYPE?". Journal of Istanbul Faculty of Medicine 84 / 4 (Ekim 2021): 559-567 . https://doi.org/10.26650/IUITFD.2021.934957
AMA Babuna Kobaner G. , Özkaya E. EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS, CAUSATIVE DRUGS, AND DIAGNOSTIC CHALLENGES OF FIXED DRUG ERUPTION IN ELDERLY PATIENTS: IS BULLOUS TYPE A MORE COMMON CLINICAL PHENOTYPE?. İst Tıp Fak Derg. 2021; 84(4): 559-567.
Vancouver Babuna Kobaner G. , Özkaya E. EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS, CAUSATIVE DRUGS, AND DIAGNOSTIC CHALLENGES OF FIXED DRUG ERUPTION IN ELDERLY PATIENTS: IS BULLOUS TYPE A MORE COMMON CLINICAL PHENOTYPE?. Journal of Istanbul Faculty of Medicine. 2021; 84(4): 559-567.
IEEE G. Babuna Kobaner ve E. Özkaya , "EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS, CAUSATIVE DRUGS, AND DIAGNOSTIC CHALLENGES OF FIXED DRUG ERUPTION IN ELDERLY PATIENTS: IS BULLOUS TYPE A MORE COMMON CLINICAL PHENOTYPE?", Journal of Istanbul Faculty of Medicine, c. 84, sayı. 4, ss. 559-567, Eki. 2021, doi:10.26650/IUITFD.2021.934957

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