Prevalence and mortality rate of severe cutaneous adverse reactions at Siriraj Hospital

Abstract

Introduction : Stevens-Johnson syndrome (SJS), Toxic Epidermal Necrolysis (TEN) and drug hypersensitivity syndrome (HSS) are severe cutaneous adverse reactions (SCAR) that is mostly related to drugs. Although incidence is rare, it has significant impact on patient’s well being because of its high mortality rates.

Objective : To investigate the causative drugs, prevalence and mortality rates related to SCAR, which were from drug exposure during 2003 - 2007.

Setting : Siriraj Hospital, Bangkok.

Research design : A retrospective study

Patients : Patients who were diagnosed to be SJS, TEN and HSS were included.

Method : Five years retrospective data, 2003 - 2007, was collected from electronic database of Adverse Drug Reaction Monitoring Center and Siriraj Computer Center.

Result : SCAR was found in 136 patients during 2003-2007 including 84 cases with SJS (61.76%), 3 cases with SJS overlap TEN (2.21%), 10 cases with TEN (7.35%) and 39 cases with HSS (28.68%). The prevalence of SJS, TEN and HSS were most often found in patients treated with carbamazepine, allopurinol and phenytoin, respectively. Mortality rate of SJS, TEN and HSS were 6.90%, 50.0% and 12.82% respectively.

Conclusion : Top three main drug groups causing SCAR were, namely: anticonvulsants (34.56%), antimicrobial (25.74%) and antigout (14.70%). Allopurinol revealed the highest mortality rate.