MyMedR

Oral fixed drug eruption due to tinidazole

Singh R, Ramachandra SS, Dayakara JK

Cutis, 2016 Dec;98(6):E1-E2.

PMID: 28099544

Matched MeSH terms: Drug Eruptions/diagnosis; Drug Eruptions/etiology*; Drug Eruptions/pathology

Sodium valproate-aggravated psoriasiform eruption

Kwan Z, Che Ismail RB, Wong SM, Tan LL, Robinson S, Lim KS

Int J Dermatol, 2014 Oct;53(10):e477-9.

PMID: 25209632 DOI: 10.1111/ijd.12579

Matched MeSH terms: Drug Eruptions/etiology*

Skin lesions induced by penicillamine. Occurrence in a patient with hepatolenticular degeneration (Wilson Disease)

Greer KE, Askew FC, Richardson DR

Arch Dermatol, 1976 Sep;112(9):1267-9.

PMID: 136925

A 41-year-old patient with hepatolenticular degeneration (Wilson disease), who had been treated for 15 years with penicillamine, developed small white papules at sites of venipuncture in the antecubital fossae and at surgical suture sites. Histologically, these papules showed focal areas of connective tissue degeneration in the dermis, but there was no evidence of inclusion cysts. The changes most likely resulted from the effect of penicillamine on new connective tissue formation at the sites of injury. The patient also developed crinkling of the skin of her face and neck while on the penicillamine regimen, and these changes were attributed, at least in part, to the effects of this drug on connective tissue.

Matched MeSH terms: Drug Eruptions/etiology*

Severe cutaneous adverse reactions and sulphadoxine-pyrimethamine in Sabah, Malaysia

Lyn PC, Fernandez E

Med J Aust, 1987 Mar 16;146(6):335-6.

PMID: 2950306

Matched MeSH terms: Drug Eruptions/epidemiology

Fixed drug eruption associated with co-trimoxazole

Mohamed KB

J Pediatr, 1999 Sep;135(3):396.

PMID: 10484812

Matched MeSH terms: Drug Eruptions/etiology*; Drug Eruptions/pathology*

Incidence of cutaneous adverse drug reactions among medical inpatients of Sultanah Aminah Hospital Johor Bahru

Latha S, Choon SE

Med J Malaysia, 2017 06;72(3):151-156.

PMID: 28733562 MyJurnal

INTRODUCTION: Cutaneous adverse drug reactions (cADRs) are common. There are only few studies on the incidence of cADRs in Malaysia.

OBJECTIVE: To determine the incidence, clinical features and risk factors of cADRs among hospitalized patients.

METHODS: A prospective study was conducted among medical inpatients from July to December 2014.

RESULTS: A total of 43 cADRs were seen among 11 017 inpatients, yielding an incidence rate of 0.4%. cADR accounted for hospitalization in 26 patients. Previous history of cADR was present in 14 patients, with 50% exposed to the same drug taken previously. Potentially lifethreatening severe cutaneous adverse reactions (SCAR), namely drug reaction with eosinophilia and systemic symptoms (DRESS: 14 cases) and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN: 6 cases) comprise almost 50% of cADRs. The commonest culprit drug group was antibiotics (37.2%), followed by anticonvulsants (18.6%). Cotrimoxazole, phenytoin and rifampicin were the main causative drugs for DRESS. Anticonvulsants were most frequently implicated in SJS/TEN (66.7%). Most cases had "probable" causality relationship with suspected drug (69.8%). The majority of cases were of moderate severity (65.1%), while 18.6% had severe reaction with 1 death recorded. Most cases were not preventable (76.7%). Older age (> 60 years) and mucosal involvement were significantly associated with a more severe reaction.

CONCLUSION: The incidence of cADRs was 0.4%, with most cases classified as moderate severity and not preventable. The commonest reaction pattern was DRESS, while the main culprit drug group was antibiotics. Older age and mucosal membrane involvement predicts a severe drug reaction.

Matched MeSH terms: Drug Eruptions/etiology; Drug Eruptions/epidemiology*

A second international co-operative investigation into thiacetazone side-effects. Rashes on two thiacetazone containing regimens

Ferguson GC, Nunn AJ, Fox W, Miller AB, Robinson DK, Tall R

Tubercle, 1971 Sep;52(3):166-81.

PMID: 4106401

Matched MeSH terms: Drug Eruptions/etiology*; Drug Eruptions/epidemiology; Drug Eruptions/therapy

Fulltext Cross-reactivity in AED-Induced Severe Cutaneous Adverse Reaction: A Case Report

Khor AH, Lim KS, Tan CT, Kwan Z, Ng CC

J Investig Allergol Clin Immunol, 2016;26(5):329-331.

PMID: 27763865 DOI: 10.18176/jiaci.0085

Matched MeSH terms: Drug Eruptions/drug therapy; Drug Eruptions/etiology*; Drug Eruptions/immunology

Fulltext Cutaneous side-effects of epidermal growth factor receptor-tyrosine kinase inhibitor (TKI) in the treatment of lung cancer: description and its management

Ong CK, Tan WC, Chan LC, Abdul Razak M

Med J Malaysia, 2012 Apr;67(2):222-3.

PMID: 22822651 MyJurnal

Epidermal growth factor receptor (EGFR)--tyrosine kinase inhibitors (TKI) like erlotinib and gefitinib have been approved as monotherapy for the treatment of patients with locally advanced or metastatic non small cell lung cancer (NSCLC) after failure of at least one prior chemotherapy regimen. The use of EGFR-TKI is associated with unique and dramatic dermatologic side effects. We report 2 patients with NSCLC developing a typical acneiform (papulo-pustular) eruption shortly after initiation of EGFR-TKI.

Matched MeSH terms: Drug Eruptions/drug therapy*

Fulltext Concurrent massive breast enlargement, myasthenia gravis and dermopathy as manifestations of penicillamine toxicity in a Wilson's disease patient

Tan SS, Latif SA, Poh WY

Med J Malaysia, 2012 Jun;67(3):323-5.

PMID: 23082426 MyJurnal

Penicillamine toxicity in Wilson's disease has been well reported but rarely seen now as newer agents are being used. We present a case who developed multiple rare complications of Penicillamine concurrently. Our patient is one of three siblings on Penicillamine, she was the only one who developed massive breast enlargement four months after commencing Penicillamine therapy, as well as dermatological adverse reactions and myasthenia gravis three more months later. All the adverse effects improved soon after substitution of the offending agent with Trientine.

Matched MeSH terms: Drug Eruptions/etiology*

Drug eruptions from phenylbutazone in Jamu

Giam YC, Tham SN, Tan T, Lim A

Ann Acad Med Singap, 1986 Jan;15(1):118-21.

PMID: 2939787

Drug eruptions from indeginous medicine is often difficult to diagnosis and confirm. It is known that a number of these now supplied by bomohs and Chinese sinsehs contain known drugs and are dispensed as tablets and capsules. We report 3 cases of adverse drug eruption to "Jamu", a Malay herb. A particular brand, "Jamu Indonesia, Toko Air Pancur", from Johor Bahru, Malaysia, is especially recommended for "sakit pinggang" or backache. The cases occurred between January and February 1985, and all had taken brown kidney shaped tablets. The adverse reactions were moderately severe. Two had erythroderma with hepatitis, and one, Steven Johnson Syndrome. Analysis of this jamu for analgesics led to the discovery of adulteration with phenylbutazone and diazepam. Records from local cases from 1974-1984 showed that 8 other patients, all Chinese had adverse cutaneous eruptions from phenylbutazone, oxybutazone and propyphenazone. The skin manifestations were erythroderma (2 cases), vasculitis (2 cases) and toxic epidermal necrolysis (4 cases). Those with toxic epidermal necrolysis had 100% mortality.

Matched MeSH terms: Drug Eruptions/etiology*

Fulltext Cutaneous drug eruptions

Adam BA

Med J Malaysia, 1982 Jun;37(2):110-3.

PMID: 6215559

Patients attending a referral Skin Clinic were studied to identify the spectrum of drug eruptions and the offending drugs. There were 51 patients with an incidence of five per thousand and equal sex incidence. Though the pattern of eruption was broadly similar to other reports, unusual reactions were observed. In addition to the skin manifestation, fever and lymphadenopathy were present in most patients. Raised erythrocyte sedimentation rate and eosinopoenia were commonly observed. Clinical acumen and the list of drugs ingested are still the best clues to the diagnosis ofdrug eruption.
Study site: Skin clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Drug Eruptions/epidemiology*

Severe generalised dermatitis with intravenous iron-dextran (Imferon) therapy

Teoh ES, Chan DP

Med J Malaya, 1966 Sep;21(1):63-5.

PMID: 4224880

Matched MeSH terms: Drug Eruptions*

Fulltext Toxic epidermal necrolysis in Malaysian adults. A retrospective study

Ting HC, Adam BA

Singapore Med J, 1985 Oct;26(6):456-9.

PMID: 2937150

We report a retrospective study of all cases of toxic epidermal necrolysis admitted to the adult medical wards of the University Hospital in Kuala Lumpur over a 16 year period from 1967 to 1983. Over this period of time only 7 cases were encountered, suggesting the condition is rare in adults in our country. All the cases were females and the age ranged from 21 to 41 years. Four cases were due to drugs, 2 were idiopathic and one was attributed to Staphylococcal infection. One patient died. The other patients recovered completely with no sequelae.

Matched MeSH terms: Drug Eruptions/etiology

Frequency of the HLA-B*1502 allele contributing to carbamazepine-induced hypersensitivity reactions in a cohort of Malaysian epilepsy patients

Then SM, Rani ZZ, Raymond AA, Ratnaningrum S, Jamal R

Asian Pac J Allergy Immunol, 2011 Sep;29(3):290-3.

PMID: 22053601

We describe the association of the HLA-B*1502 allele in 27 epilepsy patients (19 Malays, 8 Chinese) treated with carbamazepine (CBZ) at the UKM Medical Center (UKMMC), 6 with CBZ-Steven Johnson Syndrome (CBZ-SJS), 11 with CBZ-induced rash, 2 with suspected phenytoin-induced rash and 8 negative controls. Our study showed that 10 (6 Malay, 4 Chinese) patients were positive for HLA-B*1502. Out of the 10 patients, six were confirmed to have CBZ-SJS (p = 0.0006), while four patients developed a skin rash. However there were 6 Malay patients and 1 Chinese patient that developed a skin rash after CBZ administration who were not positive for the allele, indicating that there might be more that one allele associated with CBZ-induced hypersensitivity. Another 2 patients were suspected of having phenytoin-induced rash, instead of CBZ, and these patients did not have HLA-B*1502. In conclusion, this study confirmed the association of HLA-B*1502 with CBZ-SJS among Malaysian epilepsy patients, however there might be other genes that could be responsible for the CBZ-induced rash.

Matched MeSH terms: Drug Eruptions/genetics*; Drug Eruptions/immunology*

Cutaneous adverse drug reactions: A four-year audit from a district hospital in Johor, Malaysia

Kim HS, Tang MM

Med J Malaysia, 2018 12;73(6):397-399.

PMID: 30647211

Cutaneous adverse drug reactions (cADR) are common. However, only very few audits reported the clinical characteristics of cADR captured at district hospitals. We performed a 4-year audit on cADR reported to the Department of Pharmacy in Hospital Pakar Sultanah Fatimah between May 2012 and March 2016. It showed that the main adverse drug reaction (ADR) reporters were pharmacists (84.9%) where the majority of the reactions were clinical descriptions without dermatological diagnosis. Antibiotics (46.4%) were the commonest culprit drug followed by NSAIDs (22%). The most common reactions were immediate reactions, i.e. urticaria and angioedema contributing 55.7% of the cases; followed by maculopapular eruptions (41.8%). There were only six cases (1%) of severe cADR reported in this cohort. Reporting bias and the incomplete dermatological diagnosis were the main limitation of the reports.

Matched MeSH terms: Drug Eruptions/etiology; Drug Eruptions/epidemiology*

Fulltext An epidemiological and clinical analysis of cutaneous adverse drug reactions seen in a tertiary hospital in Johor, Malaysia

Choon SE, Lai NM

Indian J Dermatol Venereol Leprol, 2012 Nov-Dec;78(6):734-9.

PMID: 23075643 DOI: 10.4103/0378-6323.102367

BACKGROUND: The prevalence, clinical patterns, and causative drugs of cutaneous adverse drug reactions (cADR) vary among the different populations previously studied.
AIM: To determine the prevalence, the clinical patterns of drug eruptions, and the common drugs implicated, particularly in severe cADR such as Stevens-Johnson Syndrome/Toxic epidermal necrolysis (SJS/TEN) and drug rash with eosinophilia and systemic symptoms (DRESS) in our population.
METHODS: We analyzed the database established for all cADR seen by the department of Dermatology from January 2001 till December 2010.
RESULTS: A total of 362 cADR were seen among 42 170 new clinic attendees, yielding an incidence rate of 0.86%. The most common reaction pattern seen was maculopapular eruption (153 cases) followed by SJS/TEN (110 cases) and DRESS (34 cases). Antibiotics was the most commonly implicated drug group (146 cases) followed by anticonvulsants (81 cases) and antigout drugs (50 cases). The most frequently implicated drug was allopurinol (50 cases). Carbamazepine, allopurinol, and cotrimoxazole were the three main causative drugs of SJS/TEN accounting for 21.8%, 20.9%, and 12.7%, respectively, of the 110 cases seen, whereas DRESS was mainly caused by allopurinol (15 cases). Mortality rates for TEN, SJS, and DRESS were 28.6%, 2.2%, and 5.9%, respectively.
CONCLUSIONS: The low rate of cADR with a high proportion of severe reactions observed in this study was probably due to referral bias. Otherwise, the reaction patterns and drugs causing cADR in our population were similar to those seen in other countries. Carbamazepine, allopurinol, and cotrimoxazole were the three main causative drugs of SJS/TEN in our population.
Study site: department of dermatology in Hospital Sultanah Aminah

Matched MeSH terms: Drug Eruptions/etiology; Drug Eruptions/epidemiology*; Drug Eruptions/pathology*

Fulltext Cutaneous adverse drug reactions seen in a tertiary hospital in Johor, Malaysia

Ding WY, Lee CK, Choon SE

Int J Dermatol, 2010 Jul;49(7):834-41.

PMID: 20618508 DOI: 10.1111/j.1365-4632.2010.04481.x

BACKGROUND: Adverse drug reactions are most commonly cutaneous in nature. Patterns of cutaneous adverse drug reactions (ADRs) and their causative drugs vary among the different populations previously studied.
OBJECTIVE: Our aim is to determine the clinical pattern of drug eruptions and the common drugs implicated, particularly in severe cutaneous ADRs in our population.
MATERIALS AND METHODS: This study was done by analyzing the database established for all adverse cutaneous drug reactions seen from January 2001 until December 2008.
RESULTS: A total of 281 cutaneous ADRs were seen in 280 patients. The most common reaction pattern was maculopapular eruption (111 cases, 39.5%) followed by Stevens-Johnson Syndrome (SJS: 79 cases, 28.1%), drug reaction with eosinophilia and systemic symptoms (DRESS: 19 cases, 6.8%), toxic epidermal necrolysis (TEN: 16 cases, 5.7 %), urticaria/angioedema (15 cases, 5.3%) and fixed drug eruptions (15 cases, 5.3%). Antibiotics (38.8%) and anticonvulsants (23.8%) accounted for 62.6% of the 281 cutaneous ADRs seen. Allopurinol was implicated in 39 (13.9%), carbamazepine in 29 (10.3%), phenytoin in 27 (9.6%) and cotrimoxazole in 26 (9.3%) cases. Carbamazepine, allopurinol and cotrimoxazole were the three main causative drugs of SJS/TEN accounting for 24.0%, 18.8% and 12.5% respectively of the 96 cases seen whereas DRESS was mainly caused by allopurinol (10 cases, 52.6%) and phenytoin (3 cases, 15.8%).
DISCUSSION: The reaction patterns and drugs causing cutaneous ADRs in our population are similar to those seen in other countries although we have a much higher proportion of severe cutaneous ADRs probably due to referral bias, different prescribing habit and a higher prevalence of HLA-B*1502 and HLA-B*5801 which are genetic markers for carbamazepine-induced SJS/TEN and allopurinol-induced SJS/TEN/DRESS respectively.
CONCLUSION: The most common reaction pattern seen in our study population was maculopapular eruptions. Antibiotics, anticonvulsants and NSAIDs were the most frequently implicated drug groups. Carbamazepine and allopurinol were the two main causative drugs of severe ADRs in our population.

Matched MeSH terms: Drug Eruptions/epidemiology*

HLA-B*58: 01 association in allopurinol-induced severe cutaneous adverse reactions: the implication of ethnicity and clinical phenotypes in multiethnic Malaysia

Low DE, Nurul-Aain AF, Tan WC, Tang JJ, Bakhtiar MF, Murad S, et al.

Pharmacogenet Genomics, 2020 09;30(7):153-160.

PMID: 32433341 DOI: 10.1097/FPC.0000000000000408

OBJECTIVE: The association between human leukocyte antigen (HLA)-B*58:01 and risk of allopurinol-induced severe cutaneous adverse reactions (AIS) was observed across different populations. We explore the association between HLA-B*58:01 and AIS risk in multiethnic Malaysian population. The HLA-B*58:01 risk for different AIS clinical phenotypes and ethnicity was determined.

METHODS: We performed a case-control association study by genotyping the HLA-B alleles of 55 patients with AIS [11 toxic epidermal necrolysis (TEN), 21 Steven Johnson syndrome (SJS) 22 drug reaction wit eosinophilia and systemic symptoms (DRESS) and one acute generalized exanthematous pustulosis (AGEP)] and 42 allopurinol-tolerant controls (ATC).

RESULTS: HLA-B*58:01 was positive in 89.1 and 14.3% of the AIS and ATC study groups [odds ratio (OR) = 49.0, 95% confidence interval (CI) = 14.6-164.4, P < 0.0001)], respectively. Our data showed that 93.8% of the AIS-SJS/TEN patients and 86.4% of the AIS-DRESS patients were HLA-B*58:01 positive (AIS-SJS/TEN, OR = 90, 95% CI = 16.9-470.1, P < 0.0001 and AIS-DRESS OR = 38, 95% CI = 8.5-169.2, P < 0.0001). Stratification by ethnicity and clinical phenotypes revealed a significant increased risk between HLA-B*58:01 and Chinese-AIS patients (OR = 137.5, 95% CI = 11.3-1680.2, P < 0.0001), in particular Chinese patients with AIS-SJS/TEN phenotype (100% HLA-B*58:01 positive). HLA-B*58:01 was positive in 90.9% Chinese AIS-DRESS (P < 0.0001). Highly significant associations of HLA-B*58:01 were observed in Malay AIS-SJS/TEN (OR = 78, 95% CI = 9.8-619.9, P < 0.0001) and Malay AIS-DRESS (OR = 54, 95% CI = 6.6-442.9, P < 0.0001). Although the number of Indian-AIS patients was relatively small (n = 2), both were HLA-B*58:01 positive.

CONCLUSION: Our data suggest strong associations between HLA-B*58:01 and AIS in Malaysian population with Chinese and Malays ethnicity. The strong association was also observed in three different clinical phenotypes of AIS, mainly the AIS-SJS/TEN.

Matched MeSH terms: Drug Eruptions/genetics*

Hypersensitivity reactions to high-dose co-trimoxazole in HIV-infected Malaysian and Scottish patients

Pakianathan MR, Kamarulzaman A, Ismail R, McMillan A, Scott GR

AIDS, 1999 Sep 10;13(13):1787-8.

PMID: 10509585

Matched MeSH terms: Drug Eruptions/etiology*

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