allopurinol and Dermatitis--Exfoliative

Topics: Adult; Allopurinol; Clinical Trials as Topic; Dermatitis, Exfoliative; Drug Eruptions; Female; Hospitalization; Humans; Male; Middle Aged; Nails; Placebos; Psoriasis; Uric Acid

Severe cutaneous adverse reactions (SCARs) are potentially lethal adverse drug reactions that involve the skin, mucous membranes, and internal organs, resulting in disability. SCARs include drug-induced epidermal necrolysis, which is Steven Johnson syndrome (SJS)/ Steven Johnson syndrome and toxic epidermal necrolysis overlap (SJS-TEN overlap)/ toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalised exanthematous pustulosis (AGEP), generalised bullous fixed drug eruption (GBFDE), and acute erythroderma. Awareness of local epidemiology of SCARs plays an important role in prescribing practices by healthcare provider. Recognition of SCARs enables the offending drug to be withdrawn immediately, which is the definitive treatment of SCARs.. This is a retrospective study reviewing SCAR cases reported to the Malaysian Adverse Drug Reactions Advisory Committee (MADRAC) registry at the Department of Dermatology, Hospital Melaka, for 5 years and 3 months from December 2014 to February 2020.. A total of 41 SCARs cases were identified over the study duration. The incidence rate was 0.18%. All 41 cases require hospitalisations, with four cases (9.8%) managed in ICU and one mortality (2.4%) due to SJS-related complication. One patient had two episodes of SCARs. There were 22 male patients and 18 female patients. The majority were Malays (33, 80.5%), followed by Chinese (7, 17.1%) and Indonesian (1, 2.4%). There was no Indian patient with SCARs in this study. The mean age of patients was 47.2±17 years. Drug-induced epidermal necrolysis was the commonest type of SCARs (63.4%), and out of this, SJS accounted for the majority of cases (48.8%). Antibiotic was the main group of offending medication in this SCAR study (29.3%). The top five individual causative drugs of SCARs in sequence include allopurinol, phenytoin, carbamazepine, co-amoxiclav, and cephalexin. Allopurinol was the commonest culprit drug for drug-induced epidermal necrolysis and DRESS, phenytoin for acute erythroderma, and co-amoxiclav for AGEP.. SJS was the most common manifestation and Allopurinol was the commonest culprit drug for SCAR cases in our cohort.

Topics: Acute Generalized Exanthematous Pustulosis; Adult; Allopurinol; Amoxicillin-Potassium Clavulanate Combination; Cicatrix; Dermatitis, Exfoliative; Eosinophilia; Female; Hospitals; Humans; Malaysia; Male; Middle Aged; Phenytoin; Retrospective Studies; Stevens-Johnson Syndrome

Allopurinol is an effective urate lowering drug, which is usually well-tolerated with no adverse effects in most cases, but about 2% of the treated patients develop a skin rash, and patients may experience severe allopurinol-induced hypersensitivity syndrome.. The aim of the authors was to summarize and present the clinical manifestations of allopurinol-induced hypersensitivity in patients treated at the Department of Dermatology and Allergology, University of Szeged in order to identify potential associations with this syndrome.. Retrospective review of all patients who were referred to the department with allopurinol-induced hypersensitivity syndrome in the last four years.. During four years, 11 patients were treated with allopurinol-induced hypersensitivity syndrome. The average age was 70.3 years. Before the initiation of allopurinol therapy, 36% of patients had already suffered from various degrees of renal impairment, and 72% of them had been taking thiazide diuretics. Cutaneous manifestations were mainly generalized, erythematous, maculopapular exanthemas (9 patients, 82%), and two patients showed signs of erythema multiforme (18%). Asymptomatic hyperuricemia was the indication for allopurinol therapy in all patients.. Allopurinol-induced hypersensitivity syndrome is a severe, life-threatening disease. Administration of allopurinol should be initiated with clear indications in appropriate dose. Old age, underlying renal impairment and concomitant thiazide diuretic intake should be considered as potential risk factors for developing hypersensitivity syndrome.

Topics: Age Factors; Aged; Aged, 80 and over; Allopurinol; Dermatitis, Exfoliative; Drug Eruptions; Drug Hypersensitivity; Erythema Multiforme; Exanthema; Female; Gout Suppressants; Humans; Male; Middle Aged; Parapsoriasis; Renal Insufficiency; Retrospective Studies; Risk Factors; Sodium Chloride Symporter Inhibitors

Hyperuricemia is present in approximately 5% of the population. The vast majority is asymptomatic and at no clinical risk. Allopurinol, an analog of hypoxanthine, has been widely used in clinical practice for more than 30 years for the treatment of hyperuricemia and gout. Two percent of patients develop a mild exanthema when on this drug, which usually resolves after withdrawal of the drug. A syndrome characterized by exfoliative dermatitis, hepatitis, interstitial nephritis, and eosinophilia, termed allopurinol hypersensitivity syndrome, has been described, and its etiology related to the accumulation of one of allopurinol's metabolites, oxypurinol, of which clearance is decreased in the setting of renal insufficiency and the use of thiazide diuretics. The term DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) Syndrome has been recently used to describe an entity presenting with similar features.

Topics: Aged; Allopurinol; Dermatitis, Exfoliative; Eosinophilia; Gout Suppressants; Humans; Hyperuricemia; Male; Syndrome

Monitoring of plasma oxypurinol has been proposed to prevent allopurinol side effects. An 89-year-old man developed a severe desquamative rash, fever, eosinophilia, hepatocellular injury and renal failure after allopurinol administration. Eight hours after the last dose, plasma allopurinol was undetectable and plasma oxypurinol was 50 mumol/l. This is the first case in which severe allopurinol hypersensitivity occurred despite a simultaneous plasma oxypurinol concentration within recommended levels (below 100 mumol/l).

Topics: Aged; Aged, 80 and over; Allopurinol; Chemical and Drug Induced Liver Injury; Dermatitis, Exfoliative; Drug Eruptions; Drug Hypersensitivity; Humans; Kidney Failure, Chronic; Male; Oxypurinol; Pyrimidines

We report on a female patient with analgetic nephropathy in whom allopurinol therapy was started because of asymptomatic hyperuricemia and who 2 months later developed a syndrome characterized by icteric hepatitis, exfoliative dermatitis and progressive renal failure. After discontinuation of allopurinol and temporary peritoneal dialysis the patient recovered from the initially threatening condition. Analysis of case reports from the literature indicates that this syndrome is due to the allopurinol metabolite oxypurinol and is most frequently observed in patients with renal failure on concomitant treatment with diuretics.

Topics: Acute Kidney Injury; Aged; Allopurinol; Chemical and Drug Induced Liver Injury; Dermatitis, Exfoliative; Female; Humans; Kidney Failure, Chronic; Uric Acid

Topics: Aged; Allopurinol; Cephalosporins; Codeine; Dermatitis, Exfoliative; Dicloxacillin; Erythromycin; Female; Humans; Male; Nail Diseases

The allopurinol hypersensitivity syndrome is a rare adverse drug reaction. It usually occurs in patients with impaired renal function or when allopurinol is prescribed with a thiazide diuretic. The recognition of the characteristic features of the syndrome is vital since early aggressive therapy is indicated. A case of allopurinol hypersensitivity, possibly the first in a black African, is reported.

Topics: Allopurinol; Dermatitis, Exfoliative; Drug Hypersensitivity; Humans; Male; Middle Aged; Multiple Myeloma

The frequency of severe reactions to allopurinol has probably been underestimated. A retrospective study encompassing a five-year period has yielded 20 patients with severe hypersensitivity reactions to allopurinol. Patients with preexisting renal impairment or who were receiving concomitant thiazide diuretics appeared to be especially predisposed. Cutaneous reaction patterns included maculopapular eruptions, exfoliative dermatitis, and toxic epidermal necrolysis. eosinophilia was uncommon. Forty percent of the patients developed hepatic involvement and 45% had renal involvement. Hepatic and renal changes usually were reversible and were not unique to any one cutaneous reaction pattern. Three patients with renal involvement required prolonged administration of systemic steroids. Complications included sepsis, decubitus ulcers, and thromboembolism. Two patients required hyperalimentation. Sequelae included dry eyes, pigmentary disturbances, and keloids. Three patients died as a result of their reaction. It is concluded that allopurinol should be used only in select patients, and the dosage should be modified if renal disease exists.

Topics: Adult; Aged; Allopurinol; Chemical and Drug Induced Liver Injury; Dermatitis, Exfoliative; Drug Eruptions; Drug Hypersensitivity; Female; Humans; Kidney Diseases; Male; Middle Aged; Prednisone; Retrospective Studies; Stevens-Johnson Syndrome

Acute interstitial nephritis associated with hepatitis, exfoliative dermatitis, fever and eosinophilia is uncommon. The syndrome has been described previously in association with phenindione administration, leptospirosis and heavy metal poisoning. Four cases are described, two of which were due to phenindione sensitivity. The other two patients had been exposed to a number of toxins including allopurinol, frusemide, chlorothiazide and methyldopa so that the exact aetiological agent is unclear. Interstitial nephritis should be considered as a cause of acute renal failure in patients with other features of drug hypersensitivity.

Topics: Acute Disease; Adolescent; Adult; Allopurinol; Chemical and Drug Induced Liver Injury; Dermatitis, Exfoliative; Drug Therapy, Combination; Humans; Male; Middle Aged; Nephritis, Interstitial; Phenindione

Topics: Acute Disease; Allopurinol; Arthritis; Biopsy; Dermatitis, Exfoliative; Drug Hypersensitivity; Eosinophilia; Eosinophils; Female; Gout; Humans; Liver; Male; Middle Aged; Prednisone; Pruritus; Skin; Time Factors