STUDY OF CLINICAL AND HISTOPATHOLOGICAL PATTERN, SEVERITY, CAUSALITY AND COST ANALYSIS IN HOSPITALISED PATIENTS WITH CUTANEOUS ADVERSE DRUG REACTIONS IN A TERTIARY CARE HOSPITAL

Objectives: To assess clinical and histopathological patterns, causative drugs, causality, severity and cost of treating cutaneous adverse drug reactions (CADRs) among patients admitted in tertiary care teaching hospital. Methods: In a prospective hospital-based study over a period of one year (June 2015- June 2016), CADRs of patients admitted to the dermatology department were recorded. The data was subjected to descriptive analysis. Results: Of the total 39 cases, 24 (61.54%) were male and 15 (38.46%) were female. Maximum patients (48.7%) belonged to 21 – 40 years age group. On causality analysis, 23 cases (58.33%) were of probable type whereas 16 (41.02%) of possible type. Steven Johnson syndrome (46.15%), maculopapular drug rash (20.51%) and drug reaction with eosinophilia and systemic symptoms (15.38%) were common CADRs. There were total 55drugs which could account for observed CADRs mostly belonging to anti-epileptic (32.72%), anti-microbial (29.09 %) and NSAIDs (21.81%) classes. The most frequent offending drug was phenytoin (18.18%) followed by paracetamol (10.91%) and carbamazepine (7.27%). Maximum CADRs were of severe type (66.67%) but no mortality was observed. In all the cases where histopathological examination was done initial diagnosis made after clinical examination did not change. The average cost of hospitalization per day was Rs 535.95. Conclusion: In our study the CADRs patterns found were similar to that seen in previous studies but most common causative class responsible was antiepileptics. Knowledge about the varied clinical presentations and the common putative drugs for CADRs will enable physicians in early diagnosis, prompt treatment and reduce economic burden.