International Journal of Pharmacology and Clinical Sciences, 2014, 3, 1, 1-6.
Published: March 2014
Type: Research Article
Authors: Surabhi Dayal, Brahmita Monga, V. K. Jain, Kamal Aggarwal, and Anuradha
Author(s) affiliations:
Surabhi Dayal1, Brahmita Monga2*, V. K. Jain3, Kamal Aggarwal1, Anuradha4
1Professor, 2Post Graduate, 3Senior Professor and Head, Department of Dermatology, venereology and leprology,
4Senior Resident, Department of Preventive and social medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
Abstract
Background: Steven Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) constitute a spectrum of severe, potentially life threatening, mucocutaneous adverse drug reactions. Antimicrobial agents and anticonvulsants are the most commonly implicated drugs. This study was aimed to compare and analyse the differences in the incubation period, clinical presentation and outcome in patients of SJS/TEN caused by the antimicrobials and anticonvulsants. Materials and Methods: Patients of SJS, TEN and SJS/TEN overlap admitted in the dermatology ward of our hospital, in whom an antimicrobial agent or an anticonvulsant were found to be probable causative agent by Naranjo score were assigned to Group A and B respectively. Inpatient records of the selected patients were studied to compare the differences. Results: Total of forty patients (twenty each of Group A and B) were included in the study. Fluoroquinolones followed by chloroquine were the most commonly implicated antimicrobials. The anticonvulsants most commonly implicated were phenytoin followed by carbamazepine. Incubation period in the antimicrobial group was significantly shorter [Group A (7.32 ± 5.4 days) vs Group B (28.58 ± 19.35 days)] with p value < 0.001. The duration of stay, in the dermatology ward, was significantly longer (p value < 0.05) in the cases of TEN caused by antimicrobials (20.1 ± 7.49 days) as compared to those caused by anticonvulsants (14.5 ± 5.36 days). Three patients in Group A and one patient in Group B expired. Conclusion: A shorter incubation period and a higher morbidity and mortality were seen in the antimicrobial induced cases as compared to the anticonvulsant group.