Cutaneous adverse drug reactions in a hospital setting

A prospective survey of the number and nature of cutaneous adverse drug reactions in a hospital setting.

Six month survey of cutaneous adverse drug reactions in hospital inpatients (April to October 1992). All patients were reviewed by a specialist dermatologist who assessed the adverse drug reaction as being: (1) type A adverse reaction (ie, expected, eg, acne vulgaris from systemic steroids; (2) type B adverse reaction (ie, unexpected, eg, allergic reaction; (3) not drug related; and (4) other/do not know.

Sixty patients were reviewed; 38/60 patients (63%) had a cutaneous reaction related to their drug therapy or in-patient care. Of these, 7 had a nonallergic adverse drug reaction (type A). A further 31 had a type B adverse reaction: 27 had an allergic reaction to a systemic drug and 4 had an allergic contact dermatitis to a topical agent. 17 patients had cutaneous signs unrelated to their drug therapy, mostly a primary skin disorder (eg, eczema, psoriasis, etc). Of the remaining 5 patients it was not possible to determine the cause of the cutaneous reaction. The most common drugs associated with adverse drug reactions were the penicillin group of antibiotics, followed by frusemide, prednisone, allopurinol and carbamazepine.

Adverse drug reactions are common and may result in additional morbidity to patients. However, only half of the cutaneous adverse reactions seen were secondary to allergy. As the diagnosis of an allergic reaction to drugs may have important therapeutic implications, review by a specialist dermatologist may be indicated.