Severe cutaneous adverse reactions in a tertiary care center in Jamaica

Alicia J S McNish; Jonathan D Ho; Althea D C East-Innis

doi:10.1016/j.jdin.2024.02.007

Severe cutaneous adverse reactions in a tertiary care center in Jamaica

JAAD Int. 2024 Feb 19:15:139-146. doi: 10.1016/j.jdin.2024.02.007. eCollection 2024 Jun.

Authors

Alicia J S McNish¹, Jonathan D Ho¹, Althea D C East-Innis¹

Affiliation

¹ Dermatology Unit, Department of Medicine, University of the West Indies, Kingston, Jamaica.

Abstract

Background: Severe cutaneous adverse reactions (SCARs) are associated with morbidity and mortality.

Objective: The aim was to determine the different types of SCARs, their morphology, common offending drugs, interventions, and outcomes.

Methods: A retrospective cohort study was conducted of all patients admitted to the dermatology service at the University Hospital of the West Indies with Stevens-Johnson syndrome (SJS), SJS/toxic epidermal necrolysis overlap (TEN), TEN, drug reaction with eosinophilia and systemic symptoms and acute generalized exanthematous pustulosis between January 1, 2012 to June 1, 2022.

Results: Fifty-one cases (51) met the inclusion criteria for SCAR. SJS, SJS/TEN overlap and TEN together accounted for 71.2% of cases. SCARs were most frequent in the fourth, fifth and 6th decades of life and there was a female preponderance. Antibiotics (31%) and anticonvulsants (29%) were the most common causative agents for SCARs. Most patients had at least 1 complication. The liver was the most common extracutaneous organ affected. Mortality was 7.8%. The main cause of death was sepsis.

Limitations: Results were not generalizable. There were missing data and loss to follow-up.

Conclusion: Judicious use of antimicrobials and corticosteroids may be beneficial in treatment of severe cutaneous drug reactions.

Keywords: Stevens Johnson syndrome; Stevens Johnson syndrome/toxic epidermal necrolysis overlap; acute generalized exanthematous pustulosis; drug reaction with eosinophilia and systemic symptoms; severe cutaneous drug reactions; toxic epidermal necrolysis.