Pattern of cutaneous adverse drug reactions at a tertiary care hospital in southern India

Background: The objective of the study was to assess the pattern of cutaneous adverse drug reactions reported by active surveillance to the Pharmacovigilance center of a tertiary care hospital in southern india, and also to establish the drugs causing the same and observe the age wise and gender based incidence of such reactions.Methods: The cutaneous ADRs (CADRs) reported to the Pharmacovigilance center of the institution were analysed retrospectively during the period of March 2013 to December 2015. The various pattern of skin reactions and the most frequent drugs causing the same were established. An age wise and gender based incidence of CADRs and drugs causing them were also reported.Results: A total of 293 cases were taken for analysis. The male female ratio was 0.89-1.in our study. Among the age wise distribution of CADRs, 57(19.4%) were seen in paediatric, 194(66.2%) in adults and 33(11.2%) in geriatric age groups. The most frequent drugs to cause the CADRs were antimicrobials 183(62.4%) followed by NSAIDs 38(12.9%) and antacids 17(5.8%).Among the skin reactions urticaria/ angioedema was the most common 109(37.2%) followed by generalised pruritis 57(19.5%) and fixed drug eruption 37(12.6%). In all the age groups and both the sexes urticaria/angioedema and generalised pruritis were the leading skin reactions observed.Conclusions: As CADRs are the most common ADRs among others, it is prudent to monitor them closely, as any change in pattern with older or newer agents can alert the health care personnel in instituting the appropriate prescription patterns, which can overall impact the quality of health care positively

Extensive darier’s disease with pityriasis amiantacea, alopecia and congenital facial nerve palsy

We present a 65-year-old man with Darier disease with pityriasis amiantacea on the scalp, alopecia, and congenital facial nerve palsy

Congenital insensitivity to pain and anhidrosis: A case report from South India

Congenital insensitivity to pain with anhidrosis, also known as hereditary sensory and autonomic neuropathy type IV, is an autosomal recessive disorder characterized by the congenital lack of pain sensation, inability to sweat, episodes of recurrent hyperpyrexia, mental retardation, and self-mutilating behavior. It is an extremely rare disorder with only a handful of reports from India. A five- year- old boy, born to second-degree consanguineous parents after uneventful antenatal period, presented to us with history of recurrent unexplained fever, recurrent ulcers in the lower limbs, insensitivity to painful stimuli (like injections, vaccination) and self-mutilating behavior from early childhood. Cutaneous examination showed multiple ulcers, loss of teeth, loss of tip of the tongue (due to biting), scarring of finger tips, xerosis and lichenification. Sensory examination showed complete loss of pain and temperature sensations, but fine touch and vibration were preserved. Deep tendon reflexes were normal. Evaluation for Hansen′s disease was non-contributory. An intradermal injection of histamine did not show any flare response. Based on clinical as well as compatible histological features a diagnosis of congenital insensitivity to pain with anhidrosis was made. The ulcers were treated with appropriate antibiotics and daily dressings. The parents were counseled about appropriate care of the child