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Kutanöz ilaç erüpsiyonunun epidemiyolojik ve klinik analizi: 164 hastadan oluşan kohort çalışması

Yıl 2020, Cilt: 4 Sayı: 12, 1147 - 1151, 01.12.2020
https://doi.org/10.28982/josam.751196

Öz

Amaç: İlaç reaksiyonları medikal tedavinin önemli ve sık bir komplikasyonudur. Bu çalışmada ki amacımız, kutanöz ilaç reaksiyonu tanısı ile kliniğimizde yatırılan olgularda, sorumlu ilaçlar ve bu ilaçların neden olduğu klinik tablolar literatür bilgileri eşliğinde incelemektir.
Yöntemler: Çalışmaya Ocak 2010-Aralık 2016 tarihleri arasında kutanöz ilaç erüpsiyonu tanısı ile Haydarpaşa Numune Eğitim Araştırma Hastanesi Deri Ve Zührevi Hastalıkları Kliniğinde yatırılarak tedavi edilen 164 olgu alınmıştır. Hastaların yaşı, cinsiyeti, semptomları, laboratuar tetkikleri, tanı ve tedavi bilgileri hasta epikrizlerden incelenerek elde edildi. Demografik özellikler, reaksiyonun tipi, reaksiyona yol açtığı düşünülen ilaç grupları, multipl ilaç kullanımının varlığı, ilaç alımından döküntünün başlangıcına kadar geçen süre gibi parametreler kayıt edildi. Nedensellik ilişkisi Naranjo algoritması ile değerlendirildi. KİE'ler,
kesin, muhtemel, olası ve yok olarak gruplandırıldı. Bütün değerler yüzdelik olarak ifade edilmiştir. İlacın yol açtığı reaksiyonun şiddeti Hartwig’s Ciddiyet Değerlendirme Skalası ile değerlendirildi.
Bulgular: Çalışmaya alınan 164 hastanın 104’ü kadın (%63,4) ve 60’ı erkek (%36,6) idi. Hastalarımızın yaşları 4 ile 97 arasında değişmekle birlikte yaş ortalaması 46,3 (18,8) idi. En sık reaksiyon tipi %42,1 oranında saptadığımız ürtiker ve anjiyoödemdi. Bunu sırasıyla, %31.7 olarak saptanan makülopapüler ilaç erüpsiyonu izlemekteydi.kutanöz reaksiyonlara en sık yol açan NSAİİ’ler (%18,9), antibiyotikler (%15,2) ve bunları izleyen NSAII ve antbiyotiklerin kombinasyonu idi (%9,8). İlacın ilk alınmasından döküntünün başlangıcına kadar geçen süre saatler ile aylar arasında değişmekteydi. Bu olguların bir kısmı da öyküde geçmişte ilaçlarla ilişikli benzer reaksiyonlar tanımlamaktadır.
Sonuç: Kutanöz ilaç Erüpsiyonu ve ona neden olan ilaçların ve prognostik faktörlerin bilinmesi klinisyenler için büyük önem arz etmektedir. Bu durumda hasta bilinçlendirilmeli ve uyarıcı olarak yanında daha önce hangi ilaçların reaksiyonlara sebep olduğunu gösteren alerji kartı ya taşınması sağlanmalıdır. NSAİİ'ler, antibiyotikler ve bunları içeren kombine ilaç kullanımından mümkün olduğunca kaçınılması, antibiyotikler ve antiepileptikler konusunda dikkatli bir izlem yapılması, uzun süreden beri kullanılan ilaçların da irdelenmesi gerektiği sonucuna varıldı.

Destekleyen Kurum

yok

Kaynakça

  • 1. Temple ME, Robinson RF, Miller JC, Hayes JR, Nahata MC. Frequency and preventability of adverse drug reactions in paediatric patients. Drug Saf. 2004;27(11):819-29. doi: 10.2165/00002018-200427110-00005. PMID: 15350153.
  • 2. Kessler DA. Introducing MEDWatch. A new approach to reporting medication and device adverse effects and product problems. J Am Podiatr Med Assoc. 1994 Jan;84(1):35-8. doi: 10.7547/87507315-84-1-35. PMID: 8295131
  • 3. Zaraa I, Jones M, Trojjet S, Cheikh Rouhou R, El Euch D, Mokni M, Ben Osman A. Severe adverse cutaneous drug eruptions: epidemiological and clinical features. Int J Dermatol. 2011 Jul;50(7):877-80. doi: 10.1111/j.1365-4632.2010.04785.x. PMID: 21699528.
  • 4. Knowles SR, Shear NH. Recognition and management of severe cutaneous drug reactions. Dermatol Clin. 2007 Apr;25(2):245-53. viii. doi: 10.1016/j.det.2007.01.011. PMID: 17430761.
  • 5. Adışen E, Karaca F, Gürer MA. Dermatolojide İlaç Reaksiyonları. Turk J Dermatol 2008;2:1-5.
  • 6. Busto U, Naranjo CA, Sellers EM. Comparison of two recently published algorithms for assessing the probability of adverse drug reactions. Br J Clin Pharmacol. 1982;13(2):223-7. doi:10.1111/j.1365-2125.1982.tb01361.
  • 7. Hartwig SC, Siegel J, Schneider PJ. Preventability and severity assessment in reporting adverse drug reactions. Am J Hosp Pharm. 1992 Sep;49(9):2229-32. PMID: 1524068.
  • 8. Mokhtari F, Nikyar Z, Naeini BA, Esfahani AA, Rahmani S. Adverse cutaneous drug reactions: Eight year assessment in hospitalized patients. J Res Med Sci. 2014 Aug;19(8):720-5. PMID: 25422656; PMCID: PMC4235091.
  • 9. East-Innis AD, Thompson DS. Cutaneous drug reactions in patients admitted to the dermatology unit at the University Hospital of the West Indies, Kingston, Jamaica. West Indian Med J. 2009 Jun;58(3):227-30. PMID: 20043529.
  • 10. Naldi L, Conforti A, Venegoni M, Troncon MG, Caputi A, Ghiotto E, Cocci A, Moretti U, Velo G, Leone R. Cutaneous reactions to drugs. An analysis of spontaneous reports in four Italian regions. Br J Clin Pharmacol. 1999 Dec;48(6):839-46. doi: 10.1046/j.1365-2125.1999.00096.x. PMID: 10594488; PMCID: PMC2014315.
  • 11. Jelvehgari M, Azimi H, Montazam H. Prevalence of cutaneous drug eruption in hospitalized patients: a report from sina hospital of Tabriz. Iranian Journal of Dermatology. 2009;12(1):16-9.
  • 12. Valeyrie-Allanore L, Sassolas B, Roujeau JC. Drug-induced skin, nail and hair disorders. Drug Saf. 2007;30(11):1011-30. doi: 10.2165/00002018-200730110-00003. PMID: 17973540.
  • 13. Ahmed AM, Pritchard S, Reichenberg J. A review of cutaneous drug eruptions. Clin Geriatr Med. 2013 May;29(2):527-45. doi: 10.1016/j.cger.2013.01.008. PMID: 23571043.
  • 14. Farshchian M, Ansar A, Zamanian A, Rahmatpour-Rokni G, Kimyai-Asadi A, Farshchian M. Drug-induced skin reactions: a 2-year study. Clin Cosmet Investig Dermatol. 2015 Feb 9;8:53-6. doi: 10.2147/CCID.S75849. PMID: 25709487; PMCID: PMC4330003.
  • 15. Bigby M. Rates of cutaneous reactions to drugs. Arch Dermatol. 2001 Jun;137(6):765-70. PMID: 11405768.
  • 16. Carneiro SC, Azevedo-e-Silva MC, Ramos-e-Silva M. Drug eruptions in the elderly. Clin Dermatol. 2011 Jan-Feb;29(1):43-8. doi: 10.1016/j.clindermatol.2010.07.006. PMID: 21146731.
  • 17. Akpinar F, Dervis E. Drug Eruptions: An 8-year Study Including 106 Inpatients at a Dermatology Clinic in Turkey. Indian J Dermatol. 2012 May;57(3):194-8. doi: 10.4103/0019-5154.96191. PMID: 22707770; PMCID: PMC3371522.
  • 18. Botelho LF, Porro AM, Enokihara MM, Tomimori J. Adverse cutaneous drug reactions in a single quaternary referral hospital. Int J Dermatol. 2016 Apr;55(4):e198-203. doi: 10.1111/ijd.13126. Epub 2015 Dec 29. PMID: 26710962.
  • 19. Marzano AV, Borghi A, Cugno M. Adverse drug reactions and organ damage: The skin. Eur J Intern Med. 2016 Mar;28:17-24. doi: 10.1016/j.ejim.2015.11.017. Epub 2015 Dec 7. PMID: 26674736.
  • 20. Yawalkar N. Drug-induced exanthems. Toxicology. 2005 Apr 15;209(2):131-4. doi: 10.1016/j.tox.2004.12.023. PMID: 15767025
  • 21. Sasidharanpillai S, Riyaz N, Khader A, Rajan U, Binitha MP, Sureshan DN. Severe cutaneous adverse drug reactions: a clinicoepidemiological study. Indian J Dermatol. 2015 Jan-Feb;60(1):102. doi: 10.4103/0019-5154.147834. PMID: 25657416; PMCID: PMC4318022.

An epidemiological and clinical analysis of cutaneous drug eruption: A cohort of 164 patients

Yıl 2020, Cilt: 4 Sayı: 12, 1147 - 1151, 01.12.2020
https://doi.org/10.28982/josam.751196

Öz

Aim: Drug reactions are important and frequent complications of medical treatments. In this study we aimed to investigate the patients hospitalized with a diagnosis of cutaneous drug eruptions, implicated drugs, and related skin manifestations considering the literature.
Methods: This retrospective cohort study was performed in Haydarpaşa Numune Training and Research Hospital, Dermatology and Venereology Department. The study comprised 164 patients that were diagnosed with cutaneous drug eruption between January 2010 and December 2016. Some parameters, such as demographic characteristics, type of the reaction, culprit drug groups, multiple drug usage, time between the onset of the drug intake and beginning of the eruption were recorded. Age, gender, symptoms, laboratory tests, diagnosis and treatment information were obtained through patient files. Causal relationship was assessed by Naranjo algorithm. Adverse drug reactions were categorized as definite, probable, possible, and absent. All values were expressed in percentages. The severity of the reaction caused by the drug was assessed with Hartwig's Severity Assessment Scale.
Results: Among 164 patients, there were 104 females and 60 males with a mean age of 46.3 (18.8) years. The most commonly encountered type of drug reactions were urticaria and angioedema (42.1 %), followed by morbilliform drug eruption (31.7%). More cutaneous reactions were noted with NSAIDs (18.9%), antibiotics (15.2%) and the combination of NSAIDs and antimicrobial agents (9.8%). Time between the onset of eruption and the intake of the drug varied by hours to months. Some of these patients also described similar reactions related to drugs in the past.
Conclusion: Knowledge of these drug eruptions, the causative drugs and the prognostic factors is important for clinicians. It is recommended to advise patients to carry a list in their wallets indicating their drug allergies and/or intolerances, especially if they had a severe reaction before. We conclude that a careful follow-up should be performed with NSAIDs, antibiotics and anti-epileptics. The combination of drugs, including NSAIDs and antibiotics should be avoided as much as possible.

Kaynakça

  • 1. Temple ME, Robinson RF, Miller JC, Hayes JR, Nahata MC. Frequency and preventability of adverse drug reactions in paediatric patients. Drug Saf. 2004;27(11):819-29. doi: 10.2165/00002018-200427110-00005. PMID: 15350153.
  • 2. Kessler DA. Introducing MEDWatch. A new approach to reporting medication and device adverse effects and product problems. J Am Podiatr Med Assoc. 1994 Jan;84(1):35-8. doi: 10.7547/87507315-84-1-35. PMID: 8295131
  • 3. Zaraa I, Jones M, Trojjet S, Cheikh Rouhou R, El Euch D, Mokni M, Ben Osman A. Severe adverse cutaneous drug eruptions: epidemiological and clinical features. Int J Dermatol. 2011 Jul;50(7):877-80. doi: 10.1111/j.1365-4632.2010.04785.x. PMID: 21699528.
  • 4. Knowles SR, Shear NH. Recognition and management of severe cutaneous drug reactions. Dermatol Clin. 2007 Apr;25(2):245-53. viii. doi: 10.1016/j.det.2007.01.011. PMID: 17430761.
  • 5. Adışen E, Karaca F, Gürer MA. Dermatolojide İlaç Reaksiyonları. Turk J Dermatol 2008;2:1-5.
  • 6. Busto U, Naranjo CA, Sellers EM. Comparison of two recently published algorithms for assessing the probability of adverse drug reactions. Br J Clin Pharmacol. 1982;13(2):223-7. doi:10.1111/j.1365-2125.1982.tb01361.
  • 7. Hartwig SC, Siegel J, Schneider PJ. Preventability and severity assessment in reporting adverse drug reactions. Am J Hosp Pharm. 1992 Sep;49(9):2229-32. PMID: 1524068.
  • 8. Mokhtari F, Nikyar Z, Naeini BA, Esfahani AA, Rahmani S. Adverse cutaneous drug reactions: Eight year assessment in hospitalized patients. J Res Med Sci. 2014 Aug;19(8):720-5. PMID: 25422656; PMCID: PMC4235091.
  • 9. East-Innis AD, Thompson DS. Cutaneous drug reactions in patients admitted to the dermatology unit at the University Hospital of the West Indies, Kingston, Jamaica. West Indian Med J. 2009 Jun;58(3):227-30. PMID: 20043529.
  • 10. Naldi L, Conforti A, Venegoni M, Troncon MG, Caputi A, Ghiotto E, Cocci A, Moretti U, Velo G, Leone R. Cutaneous reactions to drugs. An analysis of spontaneous reports in four Italian regions. Br J Clin Pharmacol. 1999 Dec;48(6):839-46. doi: 10.1046/j.1365-2125.1999.00096.x. PMID: 10594488; PMCID: PMC2014315.
  • 11. Jelvehgari M, Azimi H, Montazam H. Prevalence of cutaneous drug eruption in hospitalized patients: a report from sina hospital of Tabriz. Iranian Journal of Dermatology. 2009;12(1):16-9.
  • 12. Valeyrie-Allanore L, Sassolas B, Roujeau JC. Drug-induced skin, nail and hair disorders. Drug Saf. 2007;30(11):1011-30. doi: 10.2165/00002018-200730110-00003. PMID: 17973540.
  • 13. Ahmed AM, Pritchard S, Reichenberg J. A review of cutaneous drug eruptions. Clin Geriatr Med. 2013 May;29(2):527-45. doi: 10.1016/j.cger.2013.01.008. PMID: 23571043.
  • 14. Farshchian M, Ansar A, Zamanian A, Rahmatpour-Rokni G, Kimyai-Asadi A, Farshchian M. Drug-induced skin reactions: a 2-year study. Clin Cosmet Investig Dermatol. 2015 Feb 9;8:53-6. doi: 10.2147/CCID.S75849. PMID: 25709487; PMCID: PMC4330003.
  • 15. Bigby M. Rates of cutaneous reactions to drugs. Arch Dermatol. 2001 Jun;137(6):765-70. PMID: 11405768.
  • 16. Carneiro SC, Azevedo-e-Silva MC, Ramos-e-Silva M. Drug eruptions in the elderly. Clin Dermatol. 2011 Jan-Feb;29(1):43-8. doi: 10.1016/j.clindermatol.2010.07.006. PMID: 21146731.
  • 17. Akpinar F, Dervis E. Drug Eruptions: An 8-year Study Including 106 Inpatients at a Dermatology Clinic in Turkey. Indian J Dermatol. 2012 May;57(3):194-8. doi: 10.4103/0019-5154.96191. PMID: 22707770; PMCID: PMC3371522.
  • 18. Botelho LF, Porro AM, Enokihara MM, Tomimori J. Adverse cutaneous drug reactions in a single quaternary referral hospital. Int J Dermatol. 2016 Apr;55(4):e198-203. doi: 10.1111/ijd.13126. Epub 2015 Dec 29. PMID: 26710962.
  • 19. Marzano AV, Borghi A, Cugno M. Adverse drug reactions and organ damage: The skin. Eur J Intern Med. 2016 Mar;28:17-24. doi: 10.1016/j.ejim.2015.11.017. Epub 2015 Dec 7. PMID: 26674736.
  • 20. Yawalkar N. Drug-induced exanthems. Toxicology. 2005 Apr 15;209(2):131-4. doi: 10.1016/j.tox.2004.12.023. PMID: 15767025
  • 21. Sasidharanpillai S, Riyaz N, Khader A, Rajan U, Binitha MP, Sureshan DN. Severe cutaneous adverse drug reactions: a clinicoepidemiological study. Indian J Dermatol. 2015 Jan-Feb;60(1):102. doi: 10.4103/0019-5154.147834. PMID: 25657416; PMCID: PMC4318022.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Dermatoloji
Bölüm Araştırma makalesi
Yazarlar

Dua Cebeci 0000-0001-5746-9326

Şirin Yaşar 0000-0002-4110-1874

Sema Aytekin 0000-0003-1376-1573

Fatih Göktay 0000-0002-2380-7697

Pembegul Güneş 0000-0002-4982-5156

Yayımlanma Tarihi 1 Aralık 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 4 Sayı: 12

Kaynak Göster

APA Cebeci, D., Yaşar, Ş., Aytekin, S., Göktay, F., vd. (2020). An epidemiological and clinical analysis of cutaneous drug eruption: A cohort of 164 patients. Journal of Surgery and Medicine, 4(12), 1147-1151. https://doi.org/10.28982/josam.751196
AMA Cebeci D, Yaşar Ş, Aytekin S, Göktay F, Güneş P. An epidemiological and clinical analysis of cutaneous drug eruption: A cohort of 164 patients. J Surg Med. Aralık 2020;4(12):1147-1151. doi:10.28982/josam.751196
Chicago Cebeci, Dua, Şirin Yaşar, Sema Aytekin, Fatih Göktay, ve Pembegul Güneş. “An Epidemiological and Clinical Analysis of Cutaneous Drug Eruption: A Cohort of 164 Patients”. Journal of Surgery and Medicine 4, sy. 12 (Aralık 2020): 1147-51. https://doi.org/10.28982/josam.751196.
EndNote Cebeci D, Yaşar Ş, Aytekin S, Göktay F, Güneş P (01 Aralık 2020) An epidemiological and clinical analysis of cutaneous drug eruption: A cohort of 164 patients. Journal of Surgery and Medicine 4 12 1147–1151.
IEEE D. Cebeci, Ş. Yaşar, S. Aytekin, F. Göktay, ve P. Güneş, “An epidemiological and clinical analysis of cutaneous drug eruption: A cohort of 164 patients”, J Surg Med, c. 4, sy. 12, ss. 1147–1151, 2020, doi: 10.28982/josam.751196.
ISNAD Cebeci, Dua vd. “An Epidemiological and Clinical Analysis of Cutaneous Drug Eruption: A Cohort of 164 Patients”. Journal of Surgery and Medicine 4/12 (Aralık 2020), 1147-1151. https://doi.org/10.28982/josam.751196.
JAMA Cebeci D, Yaşar Ş, Aytekin S, Göktay F, Güneş P. An epidemiological and clinical analysis of cutaneous drug eruption: A cohort of 164 patients. J Surg Med. 2020;4:1147–1151.
MLA Cebeci, Dua vd. “An Epidemiological and Clinical Analysis of Cutaneous Drug Eruption: A Cohort of 164 Patients”. Journal of Surgery and Medicine, c. 4, sy. 12, 2020, ss. 1147-51, doi:10.28982/josam.751196.
Vancouver Cebeci D, Yaşar Ş, Aytekin S, Göktay F, Güneş P. An epidemiological and clinical analysis of cutaneous drug eruption: A cohort of 164 patients. J Surg Med. 2020;4(12):1147-51.