Anti-tubercular therapy (ATT) induced exfoliative dermatitis-A case series.

Area of Science:

• Dermatology
• Infectious Diseases
• Pharmacology

Background:

• Tuberculosis (TB) is a significant global health challenge, primarily affecting the lungs.
• First-line anti-TB drugs include isoniazid and pyrazinamide.
• Cutaneous adverse drug reactions (ADRs), such as exfoliative dermatitis (erythroderma), are known but uncommon side effects of TB treatment.

Purpose of the Study:

• To report three cases of exfoliative dermatitis in tuberculosis patients undergoing anti-TB therapy (ATT).
• To identify the specific drugs responsible for the adverse reaction.
• To emphasize the importance of prompt diagnosis and management of drug-induced erythroderma.

Main Methods:

• Three tuberculosis patients presented with generalized redness, scaling, and itching after 8 weeks of ATT.
• Anti-TB therapy was immediately discontinued, and patients received antihistamines and corticosteroids.
• Sequential drug rechallenge was performed to confirm the causative agents.

Main Results:

• All three patients recovered within three weeks of discontinuing ATT and receiving supportive treatment.
• Drug rechallenge confirmed that both isoniazid and pyrazinamide triggered similar skin lesions.
• The rechallenge treatment with antihistamines and steroids also led to complete recovery within three weeks.

Conclusions:

• Exfoliative dermatitis is a serious, though uncommon, cutaneous adverse drug reaction associated with anti-TB drugs, particularly isoniazid and pyrazinamide.
• Prompt withdrawal of the offending medication, combined with appropriate medical treatment and supportive care, is crucial for a favorable prognosis.
• Physicians must exercise caution when prescribing ATT, especially isoniazid and pyrazinamide, due to the potential for severe cutaneous reactions, necessitating strict vigilance for early detection and management.