Botelho Luciane F F, Porro Adriana M, Enokihara Milvia M S S, Tomimori Jane
Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil.
Int J Dermatol. 2016 Apr;55(4):e198-203. doi: 10.1111/ijd.13126. Epub 2015 Dec 29.
Adverse cutaneous drug reactions are frequent in hospital settings and are responsible for increased morbidity, mortality, and socioeconomic costs. The objective of this study was to identify high risk factors in hospitalized patients with adverse cutaneous drug reactions.
This descriptive and retrospective study was performed with data from 117 patients admitted to a quaternary hospital over 44 months. We reviewed their epidemiological data, suspected drugs, clinical presentation, histopathological diagnosis, and outcome. Statistical analysis was performed using the chi-squared test with a significance level of 5%.
Anticonvulsants were responsible for 23.9% of cases followed by antibiotics (22.2%). In 29% of cases, patients were taking multiple medications that could have triggered their reactions. The most common clinical forms were exanthema (37.6%), drug reaction with eosinophilia and systemic symptoms (DRESS) (14.5%), and Stevens-Johnson syndrome/toxic epidermal necrolysis (12.8%). Anticonvulsants were associated with severe forms of adverse drug reactions. Most patients (89.7%) presented clinical improvement after treatment. There was a relationship between the use of anticonvulsants and atypical lymphocytes in the dermal infiltrate, as well as the clinical form DRESS and atypical lymphocytes in the dermal infiltrate.
The use of anticonvulsants was a high risk factor for severe clinical forms of drug reactions. The presence of atypical lymphocyte infiltrates in the dermis could indicate the use of anticonvulsants.
皮肤药物不良反应在医院环境中很常见，会导致发病率、死亡率增加以及社会经济成本上升。本研究的目的是确定住院患者发生皮肤药物不良反应的高危因素。
本描述性回顾性研究使用了一家四级医院44个月内收治的117例患者的数据。我们回顾了他们的流行病学数据、可疑药物、临床表现、组织病理学诊断和结局。采用卡方检验进行统计分析，显著性水平为5%。
抗惊厥药导致23.9%的病例，其次是抗生素（22.2%）。在29%的病例中，患者正在服用多种可能引发其反应的药物。最常见的临床类型是皮疹（37.6%）、伴有嗜酸性粒细胞增多和全身症状的药物反应（DRESS）（14.5%）以及史蒂文斯-约翰逊综合征/中毒性表皮坏死松解症（12.8%）。抗惊厥药与严重的药物不良反应形式相关。大多数患者（89.7%）治疗后临床症状改善。抗惊厥药的使用与真皮浸润中的非典型淋巴细胞之间存在关联，以及临床类型DRESS与真皮浸润中的非典型淋巴细胞之间也存在关联。
抗惊厥药的使用是药物反应严重临床形式的高危因素。真皮中存在非典型淋巴细胞浸润可能提示抗惊厥药的使用。
