Department of Medicine and Pediatrics, Allergy and Immunology, Program, Penn State University, Hershey, Pennsylvania.
Bach Mai Hospital, Hanoi, Vietnam.
Ann Allergy Asthma Immunol. 2019 Nov;123(5):483-487. doi: 10.1016/j.anai.2019.08.004. Epub 2019 Aug 7.
Approximately 45% of all adverse drug reactions are manifested in the skin. Although most are mild, severe cutaneous adverse reactions (SCARs) are potentially lethal.
To review the etiology and clinical manifestations of severe cutaneous adverse reactions (SCARs) and the demographic characteristics of patients with SCARs.
This study is a retrospective review of electronic medical records for patients who developed drug-induced cutaneous reactions and were treated for initial or ongoing care at a university medical center from June 4, 2008, to August 10, 2018. Search terms included Stevens-Johnson syndrome(SJS) , drug rash with eosinophilia and systemic symptoms(DRESS), acute generalized exanthematous pustulosis(AGEP), toxic epidermal necrolysis (TEN), and TEN/SJS overlap.
Of 596 cases of drug-induced rash, 35 cases (5.9%) of SCARs were encountered (male-to-female ratio, 1.06:1.0; mean age, 48.5 years). Of those 35 cases, 32 were in white patients (91.4%). The most common manifestations were DRESS (19 [54.3%]), SJS (8 [22.8%]), AGEP (6 [17.1%]), TEN (1 [2.9%]), and overlap (1 [2.9%]). Multiple causative drugs were implicated in 14 cases, whereas a single drug was responsible in 21 cases. The most common drugs implicated were antibiotics (88.1%). The most common causative antibiotics were cephalosporins (23.7%). Most of the patients with SCARs were given triamcinolone cream and prednisone alone (18 [51.4%]), methylprednisolone alone (1 [2.9%]), methylprednisolone and prednisone combined (4 [11.4%]), methylprednisolone and prednisolone (1 [2.9%]) or prednisone and prednisolone (1 [2.9%]).
The most common SCARs were, in order, DRESS, SJS, AGEP, TEN, and overlap. The most common causative drugs were, in order, cephalosporins, penicillins, trimethoprim-sulfamethoxazole, and fluoroquinolones.
大约 45%的药物不良反应都表现在皮肤上。虽然大多数是轻度的，但严重的皮肤不良反应（SCARs）是潜在致命的。
综述严重皮肤不良反应（SCARs）的病因和临床表现，以及 SCARs 患者的人口统计学特征。
本研究是对 2008 年 6 月 4 日至 2018 年 8 月 10 日在一所大学医疗中心接受药物诱导性皮肤反应初始或持续治疗的患者的电子病历进行的回顾性分析。检索词包括史蒂文斯-约翰逊综合征（SJS）、药物疹伴嗜酸性粒细胞增多和全身症状（DRESS）、急性泛发性发疹性脓疱病（AGEP）、中毒性表皮坏死松解症（TEN）和 TEN/SJS 重叠。
在 596 例药物性皮疹中，发现 35 例（5.9%）SCARs（男女性别比为 1.06:1.0；平均年龄为 48.5 岁）。35 例中，32 例为白人患者（91.4%）。最常见的表现是 DRESS（19 例[54.3%]）、SJS（8 例[22.8%]）、AGEP（6 例[17.1%]）、TEN（1 例[2.9%]）和重叠（1 例[2.9%]）。14 例涉及多种致病药物，而 21 例仅涉及一种药物。最常见的致病药物是抗生素（88.1%）。最常见的致病抗生素是头孢菌素（23.7%）。大多数 SCARs 患者单独使用曲安奈德乳膏和泼尼松（18 例[51.4%]）、单独使用甲泼尼龙（1 例[2.9%]）、单独使用甲泼尼龙和泼尼松（4 例[11.4%]）、甲泼尼龙和泼尼松龙（1 例[2.9%]）或泼尼松和泼尼松龙（1 例[2.9%]）。
最常见的 SCARs 依次为 DRESS、SJS、AGEP、TEN 和重叠。最常见的致病药物依次为头孢菌素、青霉素、甲氧苄啶-磺胺甲噁唑和氟喹诺酮类药物。
