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Genotypic and Phenotypic Characteristics of Co-Trimoxazole-Induced Cutaneous Adverse Reactions

Wimolsiri Iamsumang1, Kumutnart Chanprapaph1, Chonlaphat Sukasem2

  • 1Division of Dermatology, Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Dermatology (Basel, Switzerland)
|October 4, 2023
PubMed
Abstract

Insights

Co-trimoxazole can cause various skin reactions, with male gender, HIV, and prolonged use increasing severe risks. Specific human leukocyte antigen (HLA) types are linked to different reaction subtypes, aiding in predicting severe cutaneous adverse drug reactions (SCARs).

Area of Science:

  • Pharmacogenomics
  • Dermatology
  • Immunology

Background:

  • Co-trimoxazole is a frequent cause of cutaneous adverse drug reactions (CADRs).
  • Limited data exists on the genotypic and phenotypic characteristics of these reactions.
  • Understanding these factors is crucial for predicting and managing severe cases.

Purpose of the Study:

  • To investigate clinical features, genetic predispositions, laboratory findings, and treatment outcomes in co-trimoxazole-induced CADRs.
  • To identify variables associated with severe cutaneous adverse reactions (SCARs).
  • To explore the link between human leukocyte antigen (HLA) types and specific CADR phenotypes.

Main Methods:

  • Retrospective review of medical records for co-trimoxazole-induced CADR cases (October 2015 - October 2021).
  • Evaluation of clinical characteristics and laboratory investigations.
  • Emphasis on human leukocyte antigen (HLA) class I and HLA-DRB1 genotyping in relation to reaction subtypes.

Main Results:

  • Seventy-two patients were included; 72% were female, with a mean age of 38.0 years.
  • Common reactions included maculopapular eruption (56.9%), DRESS (23.6%), and Stevens-Johnson syndrome (12.5%).
  • Male gender, HIV infection, prophylactic, and prolonged co-trimoxazole use were associated with SCARs. Specific HLA alleles (e.g., HLA-B*38:02, HLA-A*11:01) were linked to SJS, DRESS, and MPE.

Conclusions:

  • Co-trimoxazole can induce diverse CADR phenotypes.
  • Predictors for co-trimoxazole-induced SCARs include male gender, HIV, prophylactic/prolonged use, and specific HLA alleles.
  • Genotypic and phenotypic analysis offers insights into predicting severe drug reactions.
Keywords:
Co-trimoxazoleDrug reaction with eosinophilia and systemic symptomsHuman leukocyte antigensSevere cutaneous adverse reactionsStevens-Johnson syndrome

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