Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Johor, Malaysia.
Int J Dermatol. 2010 Jul;49(7):834-41. doi: 10.1111/j.1365-4632.2010.04481.x.
Adverse drug reactions are most commonly cutaneous in nature. Patterns of cutaneous adverse drug reactions (ADRs) and their causative drugs vary among the different populations previously studied.
Our aim is to determine the clinical pattern of drug eruptions and the common drugs implicated, particularly in severe cutaneous ADRs in our population.
This study was done by analyzing the database established for all adverse cutaneous drug reactions seen from January 2001 until December 2008.
A total of 281 cutaneous ADRs were seen in 280 patients. The most common reaction pattern was maculopapular eruption (111 cases, 39.5%) followed by Stevens-Johnson Syndrome (SJS: 79 cases, 28.1%), drug reaction with eosinophilia and systemic symptoms (DRESS: 19 cases, 6.8%), toxic epidermal necrolysis (TEN: 16 cases, 5.7 %), urticaria/angioedema (15 cases, 5.3%) and fixed drug eruptions (15 cases, 5.3%). Antibiotics (38.8%) and anticonvulsants (23.8%) accounted for 62.6% of the 281 cutaneous ADRs seen. Allopurinol was implicated in 39 (13.9%), carbamazepine in 29 (10.3%), phenytoin in 27 (9.6%) and cotrimoxazole in 26 (9.3%) cases. Carbamazepine, allopurinol and cotrimoxazole were the three main causative drugs of SJS/TEN accounting for 24.0%, 18.8% and 12.5% respectively of the 96 cases seen whereas DRESS was mainly caused by allopurinol (10 cases, 52.6%) and phenytoin (3 cases, 15.8%).
The reaction patterns and drugs causing cutaneous ADRs in our population are similar to those seen in other countries although we have a much higher proportion of severe cutaneous ADRs probably due to referral bias, different prescribing habit and a higher prevalence of HLA-B1502 and HLA-B5801 which are genetic markers for carbamazepine-induced SJS/TEN and allopurinol-induced SJS/TEN/DRESS respectively.
The most common reaction pattern seen in our study population was maculopapular eruptions. Antibiotics, anticonvulsants and NSAIDs were the most frequently implicated drug groups. Carbamazepine and allopurinol were the two main causative drugs of severe ADRs in our population.
药物不良反应最常见的是皮肤类型。以前研究的不同人群中，皮肤不良反应（ADR）的模式及其致病药物各不相同。
我们的目的是确定药物疹的临床模式和常见的致病药物，特别是在我们人群中的严重皮肤 ADR 中。
这项研究是通过分析从 2001 年 1 月至 2008 年 12 月期间所有观察到的不良皮肤药物反应的数据库进行的。
在 280 名患者中观察到 281 例皮肤 ADR。最常见的反应模式是斑丘疹疹（111 例，39.5%），其次是 Stevens-Johnson 综合征（SJS：79 例，28.1%），药物反应伴嗜酸性粒细胞增多和全身症状（DRESS：19 例，6.8%），中毒性表皮坏死松解症（TEN：16 例，5.7%），荨麻疹/血管性水肿（15 例，5.3%）和固定性药物疹（15 例，5.3%）。抗生素（38.8%）和抗惊厥药（23.8%）占 281 例皮肤 ADR 的 62.6%。别嘌呤醇（39 例，13.9%）、卡马西平（29 例，10.3%）、苯妥英（27 例，9.6%）和复方磺胺甲噁唑（26 例，9.3%）是引起 281 例皮肤 ADR 的主要药物。卡马西平、别嘌呤醇和复方磺胺甲噁唑是 SJS/TEN 的三种主要致病药物，分别占 96 例 SJS/TEN 中的 24.0%、18.8%和 12.5%，而 DRESS 主要由别嘌呤醇（10 例，52.6%）和苯妥英（3 例，15.8%）引起。
我们人群中引起皮肤 ADR 的反应模式和药物与其他国家相似，尽管我们有更高比例的严重皮肤 ADR，这可能是由于转诊偏见、不同的处方习惯以及 HLA-B1502 和 HLA-B5801 的患病率较高，HLA-B1502 和 HLA-B5801 分别是卡马西平引起的 SJS/TEN 和别嘌呤醇引起的 SJS/TEN/DRESS 的遗传标志物。
在我们的研究人群中，最常见的反应模式是斑丘疹疹。抗生素、抗惊厥药和 NSAIDs 是最常涉及的药物组。卡马西平和别嘌呤醇是我们人群中严重 ADR 的两种主要致病药物。
