Retrospective Analysis Of226Inpatients With Drug Eruption

Objective:To study the demography, offending agents, clinical and laboratory features, treatment, complications, morbidity and mortality of drug eruption in our hospital,226cases of inpatients with drug eruption in the Department of Dermatology from2006to2011were analyzed.Method:Excluding other skin diseases that similar to drug eruption and exanthematous infectious diseases. Allergize drug was classified according to 《The utility of Drug Guide》.and the typing of skin lesion was classified according to the fourth edition of 《China clinical dermatology》 written by Zhao Bian. Retrospective analysis of clinical information was performed with statistical method,and get relevant conclusions.Result:We summarized226inpatients with severe drug eruption68cases among them,30.09%,and exanthematous drug eruption is the most common type,44.69%.Range of patients’age distributed from4months to81years old, and the average age was (36.54+20.81), There was no significant difference about age distribution, and the gender ratio was1:1.31.The major group of drugs causing drug eruption in our study was antimicrobials, followed by nonsteroidal anti-inflammatory drugs (NSAIDs) and antiepileptic drugs.Penicillin was the most common drug in the antimicrobials. The median latency time between the beginning of use and onset of drug eruption was depended on the drugs. The average latency of drug eruption caused by antimicrobials and NSAIDs was shorter than antiepileptic drugs.Fever was one of common symptoms of drug eruption,57.52%.Mucosal lesions presented among36.28%of patients, and preceded the onset of skin lesions in9patients. In severe drug eruption patients, incidence rate of fever was86.76%and of mucosal lesions was64.71%. Elevated liver enzymes were noticed in69.12%of severe drug eruption patients, and much higher than it of drug eruption (36.72%).Transdermal fluid loss leads to hypovolemia, changes in electrolyte levels and finally to a katabolic metabolism in severe drug eruption patients. Some of our patients had neutrophilic leukocytosis (67patients,26.65%) and neutrophilic leukocytopenia (9patients,3.98%).Hepatitis was the most common complication, there were8cases whose skin erosion was infected by germ, and3cases’phlegm was infected by germ, and2cases’blood was infected by germ, and1case’s skin erosion was infected by monilia, and5cases’mucosal lesions was infected by monilia.In our study, majority of cases were treated with systemic steroids,and started early in treatment with proper dose. The average of steroids dosage was1mg-2mg/kg.d, and the maximum dosage was4mg/kg.d.18cases in critical condition were treated with intravenous immunoglobulin, and16cases improved.11cases were treated with blood plasma.Mortality rate of drug eruption was1.77%and of severe drug eruption was5.88%. The4death patients all were TEN,and were die of infections. There were3people over the age of60in the4death cases;4cases all with high fever、heavy mucosal damage and live、kidney damage; Skin involvement area of all4cases>60%body surface area (BAS), including one case>90%; Two cases combined underlying diseases; One cases combined pulmonary infection; Two cases combined hypoproteinemia and electrolyte imbalance.Conclusion:1.The most drug eruption was exanthematous drug eruption.2.The major group of drugs causing drug eruption in our study was antimicrobials, followed by nonsteroidal anti-inflammatory drugs (NSAIDs) and antiepileptic drugs. Penicillin was the most common drug in the antimicrobials.3.Severe drug eruption often occurred with high fever and mucosal lesions, and mucosal lesions preceded the onset of skin lesions in some patients.4. Hepatitis was the most common complication, especially in Severe drug eruption.5. Systemic steroids was the formost treatment,and intravenous immunoglobulin can be used for these patients in critical condition.6. Infections was the most common complication and the most primary cause.7. The mortality of drug eruption was decided by age of patient、the amount of skin detachment、typing and underlying diseases.