Clinical Analysis Of74Cases Of Severe Drug Eruption

Background:Drug eruption, also known as drug-induced dermatitis, is the skin and mucous membrane reactions caused by the drugs entering the body through injection, oral administration, inhalation and other ways. Severe drug eruption is characterized by generalized rash accompanied by systemic symptoms of poisoning and visceral involvemen, with rapid changes in condition, severe systemic symptoms and fever, mouth, eyes, genital mucous membranes, respiratory and digestive tract damage, even involved in the system of the heart, liver and kidney, which can lead to death due to sepsis caused by secondary infections. The first time in1866, Von Hebra describes erythema exudativum multiforme. Stevens and Johnson reported in1922the main manifestation of SJS with acute skin and mucosal damage. Although the latter description of the rash in many ways was different from Hebra reported, but people have regarded the of severe erythema multiforme with mucosa damage as SJS. Toxic epidermal necrolysis (TEN) was first reported by Lyell in1956, also known as Lyell syndrome. In1970, Melish et al confirmed cases of intraepidermal blisters mainly caused by Staphylococcus aureus phage type Ⅱ55/71, and named it the staphylococcal scalded skin syndrome (SSSS), Since then TEN no longer includes the SSSS. Exfoliative dermatitis was first described by Hebra in1886, which is a syndrome caused by a serious variety of reasons. In1996, Bocquet and his colleagues named the drug eruption with multiple organ damage and eosinophils increasing syndrome DRESS. Drug eruption can be caused by many types of drugs, which more than100kinds of common allergenic drugs including antipyretic analgesics, sulfonamides, hypnotics, sedatives, antibiotics and Chinese medicine et al. These drugs can be divided into high-risk and intermediate risk group. High-risk group includes Dapsone sulfa, the B-lactam antibiotics, imidazole, non-steroidal anti-inflammatory drugs. and intermediate risk group including quinolones, aromatic anticonvulsants, and allopurinol. The pathogenesis of severe drug eruption is not yet clear, may be related to the nature of the drug, the practice of medicine, genetic factors, environmental factors and treatment dose, treatment and treatment times. In recent years, with a wide range of synthetic and semi-synthetic drugs in clinical application, the incidence of severe drug eruption is increasing year by year.Objective:To study the general rule of the development of severe drug eruption and clinical features and treatment.Methods:The clinical data of74inpatients with severe drug eruption from1998to2011in our department were retrospectively analyzed.Results:SJS was more common among74cases, accounting for48.6%(36/74),which Followed by ED. The incidence of ED in man is high than that in woman. The administration of carbamazepine was the most frequent trigger of SJS. Phenytoin sodium was the most frequent trigger of DRESS. The rash-controlled duration of Children group was less than that of adults group, meanwhile, the incidence of liver and kidney damage was less, compared with adult and elderly groups. Among those cases20were caused by antiepileptic drug,16by anti-gout drug,6by antibiotics,5by hypnotics,2by analgesics and antipyretics and2by traditional Chinese medicine. Among them allopurinol is the largest number, accounting for21.6%(16/74). The second is carbamazepine, accounting for18.9%(14/74). The incubation period of drug eruption by anti-gout drug was (22.81±7.64) days, which was longer with higher liver and kidney damage rate. Mucosal damage rates of SJS and TEN are100%while that of ED is minimum. The age of onset of DRESS was smaller than that of ED. The incubation period of DRESS and ED was longer than SJS and TEN. Daily maximum used of corticosteroids of TEN was (4.13± 2.33) mg.kg-1, which was higher than that of the other three groups. With regard to the length of hospital stays, ED was the longest, next was TEN. Complications of TEN were higher than the other three groups and its mortality was higher. The rash control time in glucocorticoids combining with IVIG group was (4.45±0.94) days, less than a single glucocorticoids group.Conclusions:The severity of drug eruption is closely related to the types of drugs and its type. The indications of using Allopurinol and carbamazepine should be weighed further. Corticosteroid combined IVIG have beneficial effects on severe drug eruption.