Skin-adverse drug reactions in the elderly: An underestimated and avoidable issue

Ageing is a major public health concern. It is often associated with frailty and polymedication, which can lead to adverse drug reactions (ADRs), including skin-related ADRs.

To describe skin-ADRs in elderly people admitted to a dermatology ward, identify causative drugs, and investigate whether these skin-ADRs were avoidable.

We conducted a single-centre, retrospective study and recruited patients aged over 70 years admitted for skin-ADRs. Included reactions consisted of maculopapular exanthema (MPE), symmetrical drug-related intertriginous flexural exanthema, fixed drug eruption, acute generalised exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), and toxic epidermal necrolysis/Stevens-Johnson syndrome.

demographics, drug hypersensitivity history, skin-ADR characteristics, causative drugs, avoidability, therapeutic outcomes, and one-year follow-up.

Between 2010 and 2020, 80 patients (57 women, mean age 82) were included. 32 % had a history of drug hypersensitivity; 64 % were polymedicated. Skin-ADRs were non-severe in 65 % (60 % MPE) and severe in 35 % (23 % DRESS, 9 % AGEP). Causative drugs were antibiotics (85 %), cardiovascular (16 %), and anticancer agents (9 %). 21 % of skin-ADRs were avoidable. 15 % developed new skin-ADRs after unintentional rechallenge during follow-up.

Greater clinical awareness of drug hypersensitivity history could improve elderly care and reduce dermatology ward hospitalisations.