Adverse cutaneous reactions to antiepileptic drugs: a five-year retrospective study

Ovo retrospektivno istraživanje ima za cilj prikazati učestalost medikamentoznih egzantema potaknutih antiepilepticima pri Klinici za dermatovenerologiju KBC-a Rijeka u petogodišnjem periodu. Pretražen je bolnički informacijski sustav prema generičkim i zaštićenim imenima svih antiepileptika registriranih u Republici Hrvatskoj. U istraživanje su uključeni svi pacijenti u kojih je postavljena dijagnoza medikamentoznog egzantema potaknutog antiepileptikom, a koji su bili pregledani i/ili liječeni pri Klinici za dermatovenerologiju KBC-a Rijeka u periodu od 1. siječnja 2015. do 31. prosinca 2019. godine. Pronađeno je ukupno 20 pacijenata, među kojima je najviše kožnih reakcija bilo je potaknuto karbamazepinom (11 pacijenata), lamotrigin je bio uzrokom kožnih reakcija u šest pacijenata, dok su okskarbazepin, pregabalin i fenitoin svaki bili uzrokom u jednog pacijenta. Najčešća kožna reakcija bio je makulopapulozni egzantem, kod osmero oboljelih, a slijede ga DRESS (od eng. drug reaction with eosinophilia and systemic symptoms) u četvero oboljelih i urtikarija u troje oboljelih. Ostale kožne reakcije bile su: fotodermatitis, fiksni medikamentozni eritem, eritrodermija, AGEP (od eng. acute generalized exanthematous pustulosis) te anularni granulom. Rezultati ovog retrospektivnog istraživanja upućuju na veliku incidenciju kožnih nuspojava uzrokovanih antiepilepticima te bi mogli potvrditi podatak o učestalosti 1-5% medikamentoznih egzantema među pacijentima na antiepilepticima. U petero od 20 oboljelih antiepileptici su uzrokovali tešku, životno ugrožavajuću kožnu reakciju praćenu zahvaćanjem unutarnjih organa.The aim of this retrospective study was to investigate the incidence of medicamentous exanthems triggered by the use of AEDs at the Department of Dermatovenerology in the CHC Rijeka in a five year period. The hospital information system of CHC Rijeka was searched according to the generic and brand names of all registered AEDs. In this study we included all patients diagnosed with a medicamentous exanthema induced by AEDs who were examined and/or treated at the Department of Dermatovenerology in CHC Rijeka from 1st January 2015 to 31st December 2019. A total of 20 patients with cADRs were found and most reactions were triggered by carbamazepine intake (11 patients), lamotrigine triggered eruptions in six patients, while oxcarbazepine, pregabalin, and phenytoin each triggered cADRs in one patient. The most common skin reaction was maculopapular exanthem in eight patients, followed by Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) in four patients and urticaria in three patients. Other skin reactions were: photodermatitis, fixed drug erythema, erythroderma, acute generalized exanthematous pustulosis and granuloma annulare. The results of this retrospective study suggest a high incidence of cutaneous side effects caused by antiepileptics and could confirm the data on the frequency of 1-5% of drug exanthemas among patients on antiepileptics. In five of the 20 patients, antiepileptics caused a severe, life-threatening skin reaction accompanied by involvement of internal organs