Hospital Melaka, Department of Dermatology, Malaysia.
Med J Malaysia. 2022 Jul;77(4):409-414.
Severe cutaneous adverse reactions (SCARs) are potentially lethal adverse drug reactions that involve the skin, mucous membranes, and internal organs, resulting in disability. SCARs include drug-induced epidermal necrolysis, which is Steven Johnson syndrome (SJS)/ Steven Johnson syndrome and toxic epidermal necrolysis overlap (SJS-TEN overlap)/ toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalised exanthematous pustulosis (AGEP), generalised bullous fixed drug eruption (GBFDE), and acute erythroderma. Awareness of local epidemiology of SCARs plays an important role in prescribing practices by healthcare provider. Recognition of SCARs enables the offending drug to be withdrawn immediately, which is the definitive treatment of SCARs.
This is a retrospective study reviewing SCAR cases reported to the Malaysian Adverse Drug Reactions Advisory Committee (MADRAC) registry at the Department of Dermatology, Hospital Melaka, for 5 years and 3 months from December 2014 to February 2020.
A total of 41 SCARs cases were identified over the study duration. The incidence rate was 0.18%. All 41 cases require hospitalisations, with four cases (9.8%) managed in ICU and one mortality (2.4%) due to SJS-related complication. One patient had two episodes of SCARs. There were 22 male patients and 18 female patients. The majority were Malays (33, 80.5%), followed by Chinese (7, 17.1%) and Indonesian (1, 2.4%). There was no Indian patient with SCARs in this study. The mean age of patients was 47.2±17 years. Drug-induced epidermal necrolysis was the commonest type of SCARs (63.4%), and out of this, SJS accounted for the majority of cases (48.8%). Antibiotic was the main group of offending medication in this SCAR study (29.3%). The top five individual causative drugs of SCARs in sequence include allopurinol, phenytoin, carbamazepine, co-amoxiclav, and cephalexin. Allopurinol was the commonest culprit drug for drug-induced epidermal necrolysis and DRESS, phenytoin for acute erythroderma, and co-amoxiclav for AGEP.
SJS was the most common manifestation and Allopurinol was the commonest culprit drug for SCAR cases in our cohort.
严重皮肤不良反应（SCARs）是一种潜在致命的药物不良反应，涉及皮肤、黏膜和内部器官，导致残疾。SCARs 包括药物引起的表皮坏死松解症，即史蒂文斯-约翰逊综合征（SJS）/史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症重叠（SJS-TEN 重叠）/中毒性表皮坏死松解症（TEN）、药物引起的嗜酸性粒细胞增多和全身性症状（DRESS）、急性全身性发疹性脓疱病（AGEP）、全身性大疱性固定性药物疹（GBFDE）和急性红皮病。了解 SCARs 的本地流行病学在医疗保健提供者的处方实践中起着重要作用。识别 SCARs 可以立即停用引起不良反应的药物，这是治疗 SCARs 的明确方法。
这是一项回顾性研究，对 2014 年 12 月至 2020 年 2 月期间在马六甲医院皮肤科向马来西亚药物不良反应咨询委员会（MADRAC）登记处报告的 5 年零 3 个月的 41 例 SCAR 病例进行了回顾。
在研究期间共发现 41 例 SCAR 病例。发病率为 0.18%。所有 41 例均需住院治疗，其中 4 例（9.8%）在 ICU 治疗，1 例死亡（2.4%）与 SJS 相关并发症有关。有 1 例患者出现了两次 SCAR 发作。22 例为男性，18 例为女性。大多数为马来人（33 例，80.5%），其次是华人（7 例，17.1%）和印度尼西亚人（1 例，2.4%）。在这项研究中，没有马来亚裔患者患有 SCARs。患者的平均年龄为 47.2±17 岁。药物引起的表皮坏死松解症是最常见的 SCARs 类型（63.4%），其中 SJS 占大多数（48.8%）。抗生素是本研究中引起 SCAR 的主要药物组（29.3%）。SCAR 研究中按顺序排列的前五名个别致病药物包括别嘌醇、苯妥英钠、卡马西平、阿莫西林克拉维酸钾和头孢氨苄。别嘌醇是药物引起的表皮坏死松解症和 DRESS 的常见致病药物，苯妥英钠是急性红皮病的常见致病药物，阿莫西林克拉维酸钾是 AGEP 的常见致病药物。
SJS 是最常见的表现，别嘌醇是我们队列中 SCAR 病例的常见致病药物。
