Clinical analysis of 922 inpatients with drug eruption

Objective To investigate the trend in incidence, causative drugs, clinical types and treatment of drug eruption. Methods Clinical data were collected from 922 inpatients with drug eruption in Huashan Hospital, Fudan University from January 2009 to December 2013, and analyzed retrospectively. Results From 2009 to 2013, the percentage of inpatients with drug eruption among all inpatients in the Department of Dermatology in a given year varied from 9.45% to 10.01%, and the percentage of inpatients with severe drug eruption among inpatients with drug eruption from 17.45% to 28.24%. Of the 922 cases, 371 (40.2%) were caused by single drugs, and 551 (59.8%) by multiple drugs. Among the 371 cases of drug eruption caused by single drugs, the top five causative drugs were traditional Chinese medicine (72 cases) , cephalosporins (38 cases) , amoxicillin (27 cases) , antipyretic analgesics (26 cases) and tetanus antitoxin (24 cases) in 278 cases of non-severe drug eruption, antiepileptic agents (33 cases) , allopurinol (28 cases) , antipyretic analgesics (7 cases) , cephalosporins (6 cases) and traditional Chinese medicine (6 cases) in 93 cases of severe drug eruption. Of the 922 patients, 422 (45.8%) presented with maculopapular eruption, 259 (28.1%) with urticaria, 135 (14.6%) with Stevens-Johnson syndrome, 49 (5.3%) with toxic epidermal necrolysis, 33 (3.6%) with drug reaction with eosinophilia and systemic symptoms (DRESS) , and 7 (0.8%) with acute generalized exanthematous pustulosis (AGEP). A total of 791 (85.8%) patients with drug eruption received glucocorticoid treatment. The dose of glucocorticoids was (47.61 ± 12.07) mg prednisone equivalent per day in 550 patients with non-severe drug eruption, and (73.10 ± 18.23) mg prednisone equivalent per day in 221 patients with severe drug eruption. Totally, 110 (11.0%) patients with drug eruption were treated with combined intravenous immunoglobulin (IVIG) because of poor response to glucocorticoids alone. Of 224 patients with severe drug eruption, only 2 (0.9%) died. Conclusions Carbamazepine and allopurinol are the main causative drugs for severe drug eruption, while traditional Chinese medicine is the first causative drug for non-severe drug eruption. From 2009 to 2013, the annual mortality of severe drug eruption decreased considerably. Key words: Drug eruptions; Carbamazepine; Allopurinol; Treatment outcome; Glucocorticoids; Immunization, passive