allopurinol and Erythema-Multiforme

The aim of this study was to examine risk factors and mortality among patients with erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).. This was a retrospective evaluation of the med-ical records of 250 patients from two Danish tertiary dermatological departments during a ten-year period.. In a total of 192 cases (77.4%), the primary diagnosis of EM (66.5%), SJS (62.2%) and TEN (100%) was confirmed, whereas the remaining cases (22.6%) were diagnosed differently. Antibiotics and allopurinol were predominantly associated with TEN, whereas SJS was associated with a broad spectrum of drugs. EM was related mainly to viral infections, predominantly herpes (30.6%); 38.2% of the causes of EM remained unknown. Patients with TEN had the highest mortality; i.e. 60% in the course of the ten-year study period: adjusted hazard ratio (HR) = 11.2 (95% confidence interval (CI): 3.65-34.35); p < 0.001 compared with EM patients. The risk of death was also increased among patients with SJS relative to patients with EM: HR = 2.60 (95% CI: 1.10-6.16); p = 0.030; however, this did not remain statistically significant after adjustment for age, co-morbidity, infection, cancer and polypharmacy, HR = 0.99 (95% CI: 0.38-2.57); p = 0.976.. We validated diagnoses in 250 patients with EM, SJS and TEN diagnosed during a ten-year period. The survival of patients with TEN was expectedly low compared with patients with EM. We extend previous findings by showing that after adjustment for confounders, the survival rates of SJS and EM are comparable.. none.. not relevant.

Topics: Adult; Allopurinol; Anti-Bacterial Agents; Antimetabolites; Denmark; Erythema Multiforme; Female; Herpes Simplex; Humans; Male; Middle Aged; Pneumonia, Mycoplasma; Proportional Hazards Models; Retrospective Studies; Risk Factors; Stevens-Johnson Syndrome

Topics: Allopurinol; Dermatitis, Atopic; Diagnosis, Differential; Drug Hypersensitivity Syndrome; Enzyme Inhibitors; Erythema Multiforme; Erythema Nodosum; Exanthema; Female; Fever; Humans; Middle Aged

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

Cutaneous adverse drug reactions (CADRs) are common skin adverse reactions associated with drugs.. To assess recent trends in CADRs and the drugs associated with them, using data from the past 5 years in the largest single database available on a hospital-based population in China.. All clinical records of inpatients admitted with a diagnosis of CADR to the Dermatology Ward, Huashan Hospital from January 2004 to December 2008 were retrospectively studied.. In the 734 patients, the three most common types of CADRs were nonsevere reactions, erythema multiforme (EM)-like eruptions (n = 255), urticaria (n = 192) and exanthematous reactions (n = 159), followed by three severe reactions: Stevens-Johnson syndrome (n = 58), toxic epidermal necrolysis (n = 29) and exfoliative dermatitis (n = 22). The most common single drug associated with the development of all drug eruptions was allopurinol, followed by amoxicillin, cephalosporins, antiepileptic agents and antipyretic/analgesic agents. However, the most common single drugs associated with severe reactions were antiepileptic agents, followed by allopurinol, antipyretic/analgesic agents and cephalosporins. In contrast to patients with nonsevere reactions, patients with severe reactions were more likely to be male (P < 0.001) and to have a greater mean age of onset (P < 0.001), a longer latency period (P < 0.001) and a longer duration of hospitalization (P < 0.001).. In contrast to previous studies, we found allopurinol to be the most common single drug associated with CADRs followed by antibiotics (amoxicillin and cephalosporins), and antiepileptic, especially carbamazepine. A higher incidence of EM-like eruptions and urticaria was also seen.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Allopurinol; Analgesics; Anti-Bacterial Agents; Anticonvulsants; Child; China; Drug Eruptions; Erythema Multiforme; Exanthema; Female; Gout Suppressants; Hospitalization; Humans; Length of Stay; Male; Middle Aged; Retrospective Studies; Sex Factors; Time Factors; Urticaria; Young Adult

Use of pharmacogenetics to inform treatment decisions remains a priority for clinicians, patients and public health agencies. We previously developed a framework for systematically assessing whether pharmacogenetic test information would likely bring value to clinical decision-making and enjoy practical uptake. We applied this tool to allopurinol to determine potential usefulness of HLA genetic information in assessing risk for allopurinol-induced severe cutaneous adverse reactions. We quantified allopurinol use data and the magnitude of adverse event signals using US FDA databases, reviewed reported cases of allopurinol-associated severe cutaneous adverse reactions to assess whether clinical subtypes of patients could be identified, performed pooled analyses of associations between HLA variation and allopurinol-induced severe cutaneous adverse reactions and described considerations in clinical implementation of allopurinol pharmacogenetics.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Allopurinol; Child; Erythema Multiforme; Female; Genetic Association Studies; Genetic Testing; Genetic Variation; Gout; Gout Suppressants; HLA Antigens; Humans; Hyperuricemia; Male; Middle Aged; Pharmacogenetics; Risk Assessment; Skin Diseases; Stevens-Johnson Syndrome

1) Lyell syndrome is characterised by toxic epidermal necrolysis in which epidermal detachment affects more than 30% of the body surface area. Stevens-Johnson syndrome is a minor form affecting less than 10% of the body surface area; 2) Patients who present with these cutaneous symptoms, along with throat pain, red eyes and a damaged or detached oral mucosa must be hospitalised immediately; 3) Lyell syndrome is exclusively caused by drugs while Stevens-Johnson syndrome can also be caused by bacteria and viruses. Rapid withdrawal of the drug improves prognosis.

Topics: Allopurinol; Anti-Infective Agents; Anti-Inflammatory Agents; Anticonvulsants; Erythema Multiforme; Humans; Stevens-Johnson Syndrome; Sulfonamides; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Allopurinol; Amoxicillin; Drug Eruptions; Erythema Multiforme; Female; Humans; Intradermal Tests

Topics: Allopurinol; Desensitization, Immunologic; Erythema Multiforme; Gout; Gout Suppressants; Humans; Male; Middle Aged; Treatment Outcome

Topics: Acute Kidney Injury; Aged; Allopurinol; Drug Hypersensitivity; Erythema Multiforme; Fatal Outcome; Gout Suppressants; Humans; Male; Middle Aged