Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
Original Article
2001:67:5;238-239
PMID: 17664759

A study of drug eruptions by provocative tests

J Das, AC Mandal
 Department of Dermatology & STD, Gauhati Medical College, Guwahatt - 781 032, India

Correspondence Address:
J Das
Department of Dermatology & STD, Gauhati Medical College, Guwahatt - 781 032
India
How to cite this article:
Das J, Mandal A C. A study of drug eruptions by provocative tests. Indian J Dermatol Venereol Leprol 2001;67:238-239
Copyright: (C)2001 Indian Journal of Dermatology, Venereology, and Leprology

Abstract

Sixty cases of drug eruptions were observed during the period of one year. The incidence of drug eruption was 0.47% amongst all Dermatology O.P.D. attendances. Male to female ratio was 7:3. The highest number of cases were seen in the age group of 21-30 years. Fixed drug eruptions were the most frequent (58.3%), followed by urticaria and angioedema (20%). The drug sulphonamides (including co-trimoxazole) accounted for the highest number of eruptions (35%). The other drugs which were responsible for the eruptions, in order of frequency, were oxyphenbutazone, ampicillin, analgin, penicillin, tetracycline, ibuprofen, paracetamol, phenylbutazone, acetaminophen and phenobarbitone.
The causative drug (s) were confirmed by provocation tests in 42 (70%) cases.
Keywords: Drug eruption, Provocation test

Introduction

Allergic drug reactions are the most frequent and most important adverse reactions of a drug. About 30% of all adverse reactions to drugs involve the skin.[1] Skin can be involved in two ways: 1) Dermatitis medicamentosa due to locally applied medicine and (2) Drug eruptions due to systemically administered drug. Systemically administered drugs can produce a variety of reaction patterns. Frequently, pruritus is the only manifestation of a drug reaction and can precede the eruption.[2] Other commonly encountered reactive patterns are: 1) Urticaria and angio-oedema (2) Exanthematous eruptions including macular, papular, papulovesicular, papulosquamous, vesiculo-bullous and purpuric eruptions : (3) Erythema multiforme : (4) Stevens - Johnson syndrome : (5) Toxic epidermal necrolysis : (6) Exfoliative dermatitis (7) Lupus erythematosus - like syndrome (8) Lichenoid eruptions : and (9) fixed drug eruptions.

Provocation with the suspected drug is the only definite proof for establishing diagnosis of drug eruptions.

Materials and Methods

The material for this study comprised of 60 patients suspected to have drug eruption, who reported at the out-patient department of Dermatology and Venereology of Gauhati Medical College.

A detailed history was taken in every case with special emphasis on the timings and dosages of all the drugs taken by the patient with the exact timings of the onset of drug eruption and its subsequent evolution. They were also asked about the duration of the present epidose, any aggravating factor(s) and the treatment already taken. The timings of withdrawal of any such drug(s) and the effect of the withdrawal in respect to his/her symptoms were carefully recorded.

Provocation test

When the patient was symptom free clinically, they were subjected to provocation test with all the suspected drugs taken by the patient with all necessary preventive measures. On the first day, the patient was given one-fourth to half of the therapeutic dosage. If there was no reaction during the next 24 hours, the patient was given full therapeutic dosage on the second day. If still there was no reaction, on the third day the patient was given one day′s full therapeutic dosage. If still there was no reaction the drug was considered safe. In this manner each patient was tested with all the drugs thought to be responsible for the eruptions.

Results

The clinical types of drug eruption have been presented in [Table - 1].

The drugs responsible for the eruption have been presented in [Table - 2].

Results of provocation tests are given in [Table - 3].

Discussion

The study shows that the group of drugs most often responsible for eruptions were antimicrobial drugs (55%) followed by antipyretic - analgesic drugs (40%). One case (1.7%) was caused by phenobarbitone, while in 2 (3.3%) cases the responsible drugs could not be identified. Of the anti-microbial drugs, sulphonamides were most often involved followed by ampicillin, penicillin and tetracycline. Similar observations were also reported by Mehta et al,[3] Kauppinan,[4] Kauppinen et al,[5] and Hanumanthappa.[6] But Mani et al,[7] reported that thiacetazone was the most common antimicrobial drug to cause eruptions.

Oxyphenbutazone (13.3%) was the most frequent offending antipyretic - analgesic group to cause drug eruptions followed by analgin. This increase may be due to free availability of this drug in rural as well as in urban areas in this region and low cost of the drug. In our series, the CNS depressant drug phenobarbitone was responsible for eruption in one case only. The incidence was very low when compared to other workers.[4],[1],[7],[8] This difference is apparently due to decreased use of barbiturates since the introduction of other relatively safer drugs.

In regards to drug associated with clinical types of eruptions, it was observed that sulphonamides produced the largest number of FDE (25%), followed by oxyphenbutazone (13.3%), similar to observation of Mani et al.[7] While in the series of Alanko et all from Finland, sulphonamides caused largest number of exanthematous eruptions (12%). This may be explained on the basis of regional variation.

Provocation tests were done in all the cases with the suspected drugs. It was observed that 70% of cases showed positive results. The likely cause of negative results in the remaining cases may be wrong diagnosis of cases, smaller provocation test dosage, patient in refractory period with temporary lack of response to the test dosage. Our observations were more or less similar to the observation of Kauppinnea et al,[5] and Alanko et al.[8]

In this study, positivity of provocation test was highest with FDE (82.8%) similar to the study carried but by Alanko et al.[8] It may be due to correct diagnosis and because it represents a type of eruption caused solely by drugs.

References
1.
Alanko K, Stubb S an Kauppinen K. Cutaneous drug reactions: Clinical types and causative agents. Acta Derm Venereol 1989 ; 69: 223 - 226.
[Google Scholar]
2.
Merct Y, Miecher PA. Cutaneous melanoma following cyclosporin- A therapy for renal transplant. Br J Dermatol 1990 ; 123 : 237.
[Google Scholar]
3.
Metha T K., Marquis, L Shetty JN. A study of 70 cases of drug eruptions. Indian J of Dermatol Venereol. 1971 ; 37 : 1-5.
[Google Scholar]
4.
Kauppinen K. Cutaneous reactions to drugs. Acta Derm Venereol 1972 ; 52 : 1-89.
[Google Scholar]
5.
Kauppinen K, Stubb S. Drug eruptions : causative agents and clinical types (A series of in-patients during a 10 years period). Acta Derm Venereol 1984 ; 64 : 320 - 324.
[Google Scholar]
6.
Hanumanthappa H. A clinical study of drug eruptions - 50 cases. VII International Congress of Dermatology, New Delhi, India (Feb 26 - March 2) 1994; 59 PP.
[Google Scholar]
7.
Mani MZ,Mary Mathew. A study of 218 drug eruptions. Indian J Dermatol Venereol Lepr 1983 ; 49 : 109 - 117.
[Google Scholar]
Show Sections