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      Medicamentos inductores a reacciones cutáneas severas reportados en países de Iberoamérica Translated title: Severe cutaneous adverse reactions drugs reported in Ibero-American countries

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          Abstract

          Resumen Objetivos: Identificar los medicamentos inductores a reacciones adversas cutáneas severas que se han reportado hasta el año 2020 en países de Iberoamérica, identificando los medicamentos inductores que se asocian a cada síndrome (SSJ, NET, DRESS y PEAG). Métodos: Estudio retrospectivo, no experimental. Se realizó una revisión sistemática de la literatura médica relacionada a los medicamentos inductores de reacciones adversas cutáneas severas en Iberoamérica, expuesta en la base de datos PubMed, Scopus, Scielo y Google académico, limitando la búsqueda a artículos publicados en español y sin límites de tiempo. 27 de 574 publicaciones identificaron los medicamentos inductores a reacciones adversas cutáneas severas, excluyendo los casos de estas reacciones en las que no se especificó su asociación secundaria a medicamentos. Resultados: Los hallazgos incluyeron reportes de los siguientes países: Argentina, Costa Rica, Guatemala, México, Paraguay, Ecuador, Perú y España. Entre los medicamentos inductores a reacciones adversas cutáneas severas reportados, se incluyeron aquellos pertenecientes a diversos grupos terapéuticos: anticonvulsivos, AINES, inhibidores de la xantina oxidasa, antimicrobianos, antirretrovirales, sales de oro y antagonistas de canales de calcio, todos ellos con un pronóstico entre grave y mortal. Conclusiones: Se determinó que los medicamentos inductores a reacciones adversas cutáneas severas comprendieron una amplia variedad, pertenecientes a diversos grupos terapéuticos, siendo los más frecuentes: anticonvulsivantes, alopurinol y algunos antibióticos. No se observó una tendencia específica de algún medicamento por país o región.

          Translated abstract

          Abstract Aim: Identify induce severe skin reaction´s drugs that have been reported up to 2020 in Iberoamerican countries, recognizing the associated drugs with each syndrome (SSJ-NET, DRESS and AGEP). Data selection and methodology: A retrospective, non-experimental study was performed based on a systematic review of the medical literature related to induce sever skin reation´s drugs available in the databases of PubMed, Scopus, Scielo and Google scholar. The search and data selection were limited on reviewed articles published in Spanish, with no time limit. 27 of 574 clinical cases identified the drugs that induce serious skin reactions, excluding the cases of patients with skin reactions that do not specify whether they are secondary to drugs. Results: The findings included the report from the following countries: Argentina, Costa Rica, Guatemala, Mexico, Paraguay, Ecuador, Peru and Spain. The reported drugs that cause server skin reactions, belong to the following therapeutic groups: anticonvulsants, antibacterials, antiretrovirals, minocycline, lamotrigine, gold sales, beta-lactams, macrolides, quinolones, antifungals, calcium channel blockers, protease inhibitors, nonsteroidal anti-inflammatory drugs and acetaminophen; presenting pharmacological interactions, all of them between serious and fatal prognosis. Conclusions: When comparing the findings, it was determined that the drugs that cause server skin reactions belong to many diverse therapeutic groups, being the more frequently: anticonvulsants, alopurinol and some antibiotics. No specific tendency was found related on a specific drug reported on the analyzed countries.

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          Most cited references56

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          Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study.

          Cases of severe drug hypersensitivity, demonstrating a variable spectrum of cutaneous and systemic involvement, are reported under various names, especially drug reaction with eosinophilia and systemic symptoms (DRESS). Case definition and overlap with other severe cutaneous adverse reactions (SCAR) are debated.
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            Risk factors for acute generalized exanthematous pustulosis (AGEP)-results of a multinational case-control study (EuroSCAR).

            Acute generalized exanthematous pustulosis (AGEP) is a disease characterized by the rapid occurrence of many sterile, nonfollicular pustules usually arising on an oedematous erythema often accompanied by leucocytosis and fever. It is usually attributed to drugs. To evaluate the risk for different drugs of causing AGEP. A multinational case-control study (EuroSCAR) conducted to evaluate the risk for different drugs of causing severe cutaneous adverse reactions; the study included 97 validated community cases of AGEP and 1009 controls. Results Strongly associated drugs, i.e. drugs with a lower bound of the 95% confidence interval (CI) of the odds ratio (OR) > 5 were pristinamycin (CI 26-infinity), ampicillin/amoxicillin (CI 10-infinity), quinolones (CI 8.5-infinity), (hydroxy)chloroquine (CI 8-infinity), anti-infective sulphonamides (CI 7.1-infinity), terbinafine (CI 7.1-infinity) and diltiazem (CI 5.0-infinity). No significant risk was found for infections and a personal or family history of psoriasis (CI 0.7-2.2). Medications associated with AGEP differ from those associated with Stevens-Johnson syndrome or toxic epidermal necrolysis. Different timing patterns from drug intake to reaction onset were observed for different drugs. Infections, although possible triggers, played no prominent role in causing AGEP and there was no evidence that AGEP is a variant of pustular psoriasis.
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              Morbidity and Mortality of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in United States Adults.

              Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening disorders. Our study objective was to describe the incidence, costs of care, length of stay, comorbidities, and mortality of SJS and TEN in US adults. The Nationwide Inpatient Sample 2009-2012, containing a 20% sample of all US hospitalizations, was analyzed. We used a validated approach involving International Classification of Disease, 9th edition, Clinical Modification codes to identify SJS, SJS/TEN, and TEN (n = 2,591, n = 502, and n = 564, respectively). The mean estimated incidences of SJS, SJS/TEN, and TEN were 9.2, 1.6, and 1.9 per million adults per year, respectively. SJS/TEN was associated with nonwhite race, particularly Asians (odds ratio = 3.27, 95% confidence interval = 3.02-3.54) and blacks (odds ratio = 2.01, 95% confidence interval = 1.92-2.10). Significantly prolonged length of stay and higher costs of care (SJS: 9.8 ± 0.3 days, $21,437 ± $807; SJS/TEN: 16.5 ± 1.0 days, $58,954 ± $5,238; TEN: 16.2 ± 1.0 days, $53,695 ± $4,037) were observed compared with all other admissions (4.7 ± 0.02 days, $11,281 ± $98). Mean adjusted mortality was 4.8% for SJS, 19.4% for SJS/TEN, and 14.8% for TEN. SJS, SJS/TEN, and TEN pose a substantial health care burden. Predictors of mortality included increasing age, increasing number of chronic conditions, infection (septicemia, pneumonia, tuberculosis), hematological malignancy (non-Hodgkin's lymphoma, leukemia), and renal failure (P ≤ 0.03 for all). Further studies are needed to confirm mortality findings to improve prognostication of SJS/TEN.
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                Author and article information

                Journal
                ofil
                Revista de la OFIL
                Rev. OFIL·ILAPHAR
                Organización de Farmacéuticos Ibero-Latinoamericanos (Madrid, Madrid, Spain )
                1131-9429
                1699-714X
                June 2023
                : 33
                : 2
                : 174-181
                Affiliations
                [3] orgnameHospital Nacional San Juan de Dios de Santa Ana orgdiv1Servicio de Dermatología El Salvador
                [2] orgnameUniversidad de San Carlos de Guatemala orgdiv1Facultad de Ciencias Químicas y Farmacia orgdiv2Unidad de Investigaciones en Farmacogenética y Farmacogenómica Guatemala
                [1] orgnameUniversidad Mariano Gálvez orgdiv1Facultad de Química Biológica Guatemala
                Article
                S1699-714X2023000200013 S1699-714X(23)03300200013
                10.4321/s1699-714x2023000200013
                215337a4-b1d4-4249-9f59-ebec6923b1e8

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 28 June 2021
                : 16 June 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 56, Pages: 8
                Product

                SciELO Spain

                Categories
                Revisión

                toxicoderma,Síndrome de Stevens-Johnson,NET,DRESS,pustulosis exantemática aguda generalizada,toxicodermiasdermias,Stevens-Johnson syndrome,acute generalized exanthematous pustulosis

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