الفهرس 
Definition & ClassificationOnly 14 pages are availabe for public view
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Abstract
All drugs can potentially produce untoward consequences, even when used according to recommended methods of administration.
Adverse drug events are an important challenge in modern medicine.
They have a considerable negative impact on both health and healthcare
costs.
The incidence of CADRs is estimated to be 1-2% in the general
population. Newer insights have been developing in the field of factors
affecting CADRs and the need for studies in the Egyptian population
regarding the newer trends in cutaneous adverse effects and a comparison
of the same among a large population base, including attendants of two
main university hospitals.
This study was thus aimed to assess the percentage of CADRs, their
clinical patterns and factors affecting them, especially among two large
populations including dermatology outpatients of two main university
hospitals in Mansoura and Benha; and assessing them through an
approach to reach a diagnosis, which is the vital pillar to manage any case
of CADR.
The patients were assessed through history and clinical examination.
Data were collected from the dermatology outpatient clinics of Benha and
Mansoura University Hospitals and the percentage of CADRs was
calculated.
Summary and Conclusions
88
The study included 278 patients of CADRs with 306 drugs
implicated over a period of 6 months in the dermatology attendants of
outpatient clinics of Benha and Mansura University Hospitals. The
percentage of CADRs among dermatology outpatients was 1.1%.
In this study, the number of female patients outnumbered male
patients with a female to male ratio of 2:1. Seventy percent of studied
patients belonged to the age group ranged from 21-60 years. There was
progressive decline in the number of CADRs towards the extremes of
age; 20.5% belonged to the age group ranged from 0-20 years and 9.4%
aged more than 60 years.
Infections (15.1%) were the commonest encountered underlying comorbid
disease in this study, with increase the association of upper
respiratory tract infections with maculopapular reactions. Underlying
autoimmune disorders did not form a major associated disease, with only
thirteen patients (4.7%) found to have such disorders. Only one patient
had associated malignancy. History of atopy was present in 52.1% of
cases of urticarial drug eruptions. Obesity was an important risk factor for
CADRs constituting 52.5% of studied patients.
The most common cutaneous adverse drug reactions seen in our
patients were urticaria (25.5%), followed by fixed drug eruptions
(12.60%); exanthematous drug eruption (10.79%), erythema multiforme
(9.71%), drug-induced purpura (8.63%), drug-induced photosensitivity
reactions (8.27%), drug-induced pigmentation (7.19%), drug-induced
erythema nodosum (6.83%), and drug-induced acne (5.40%).
Summary and Conclusions
011
The pattern of distribution of various rashes in this study was found
most frequently to be localized (50.4%) followed by generalized (41.0%)
and photo-distributed (8.6%).
Most cases of the studied drug-induced pigmentations and acneiform
eruptions were reported in female patients; while the number of male
patients with FDE outnumbered the female patients.
The mean reaction time for the various drug eruptions in this study
were 1 day in urticaria/angioedema, 15 days for fixed drug eruptions, 14
days for maculopapular reactions, erythema multiforme, and Stevens
Johnson syndrome, 7 days for toxic epidermal necrolysis, and 18 days for
drug induced vasculitis. In acneiform drug eruptions; drug induced
pigmentations; and lichenoid drug reactions, the reaction time may take
months to occur.
Antimicrobials were found to be the most common cause of CADRs
in both hospitals, while analgesics/ antipyretics were the second culprit.
When rashes were studied individually, antimicrobials were the most
common cause of maculopapular reactions, fixed drug eruptions, and
toxic epidermal necrolysis in both hospitals. The most common cause of
urticaria was found to be analgesics/ antipyretics. Acneiform eruptions
were caused by steroids in all of cases. Although fixed drug eruptions
were most commonly caused by antimicrobials (especially cotrimoxazole
and metronidazoles), NSAIDs was also implicated in a
substantial number of cases.
Drug reactions were seen mostly to orally ingested drugs, with only a
few appearing after intravenous or intramuscular drug administration and