Department of Dermatology, University of Cagliari, Cagliari, Italy.
J Eur Acad Dermatol Venereol. 2012 Nov;26(11):1424-30. doi: 10.1111/j.1468-3083.2011.04313.x. Epub 2011 Oct 24.
Allopurinol is extensively prescribed for conditions associated with urate excess, despite being responsible for severe cutaneous adverse drug reactions (ADR).
A cross-sectional survey of allopurinol cases observed at the main Dermatology Department with inpatients facilities in southern Sardinia. (approx 560,836 inhabitants).
Data collection of all consecutive patients referred for ADR between 2001 and 2010. Causality assessment followed the WHO Collaborating Centre for Drug Monitoring criteria; illness severity score was adopted for toxic epidermal necrolysis (SCORTEN).
Allopurinol was the culprit drug in 84 of 780 cutaneous ADR cases (10.7%; 8.4 cases/year). Mean age was 74 years, 58% of the patients were female, 95% of patients required hospitalization. Clinical forms were maculo-papular eruptions (34 cases), Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (31 cases), vasculitis (six cases), Drug Rash Eosinophilia and Systemic Symptoms (DRESS) (three cases), Acute Generalized Exanthematous Pustolosis (AGEP) (three cases), Pityriasis rosea-like eruption (three cases), lichenoid dermatitis (two cases), fixed drug eruption (one case), erythroderma (one case). The indication for allopurinol prescription was asymptomatic hyper-uricemia in 95% of the patients. Twelve patients were under allopurinol dosage adjustment according to creatinine clearance. Final causality assessment was definite for 12% of the cases and probable for the remaining 88%. Full recovery was achieved in 88% of subjects; ten SJS/TEN patients died (12% overall mortality; 32% mortality of the SJS/TEN cases).
Considering the populations size of Southern Sardinia, is plausible that 1.5/100,000 Sardinian will be affected by allopurinol related ADR per year. Advanced age, and inappropriate allopurinol prescription were the main conditions affecting morbidity and mortality.
尽管别嘌醇可引起严重的皮肤不良反应（ADR），但其仍广泛用于治疗尿酸过多相关疾病。
对撒丁岛南部一家设有住院病房的主要皮肤科所观察到的别嘌醇病例进行横断面调查。（约 560,836 居民）。
收集 2001 年至 2010 年间所有因 ADR 就诊的连续患者的数据。采用世界卫生组织合作药物监测中心标准评估因果关系；采用毒性表皮坏死松解症严重程度评分（SCORTEN）评估疾病严重程度。
84 例皮肤 ADR 病例（10.7%；8.4 例/年）的致病药物为别嘌醇。平均年龄为 74 岁，58%的患者为女性，95%的患者需要住院治疗。临床类型为斑丘疹样皮疹（34 例）、史蒂文斯-约翰逊综合征/中毒性表皮坏死松解症（31 例）、血管炎（6 例）、药物疹伴嗜酸性粒细胞增多和全身症状（DRESS）（3 例）、急性泛发性发疹性脓疱病（AGEP）（3 例）、玫瑰糠疹样疹（3 例）、苔藓样皮炎（2 例）、固定性药疹（1 例）、红皮病（1 例）。95%的患者因无症状高尿酸血症而开具别嘌醇处方。12 名患者根据肌酐清除率调整了别嘌醇剂量。最终因果关系评估为明确 12%，可能 88%。88%的患者完全康复；10 例 SJS/TEN 患者死亡（总死亡率 12%；SJS/TEN 病例死亡率 32%）。
考虑到撒丁岛南部的人口规模，每年每 100,000 名撒丁岛居民中就有 1.5 人可能会受到别嘌醇相关 ADR 的影响。高龄和不适当的别嘌醇处方是影响发病率和死亡率的主要因素。
