Background: With limited data on the clinic-demographic profile of severe cutaneous adverse drug reactions (SCARs), this study aimed to analyze the clinical parameters, laboratory findings, mortality, and outcomes of SCARs in the Indian population.
Patients and methods: A retrospective review was conducted for patients diagnosed with SCARs-Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS)-from January 2019 to June 2024. Clinical and investigational data of outpatient and hospitalized cases were obtained from medical records.
Results: Forty-nine cases of SJS-TEN and 115 cases of DRESS were analyzed. The mean age was 38.1 ± 18.3 years (range 8-73) for SJS-TEN and 44.1 ± 17.0 years (range 7-82) for DRESS. Antiepileptics were the most commonly implicated drugs in both groups (SJS-TEN: 51%; DRESS: 33%). Mortality was seen in 1/115 in DRESS (hepatic involvement) and 10/49 (20.4%) in SJS-TEN, with refractory septic shock being the most common cause in SJS-TEN. Key predictors of mortality in SJS-TEN included higher body surface area involvement, SCORe of toxic epidermal necrosis (SCORTEN) ≥2, systemic involvement, nasal mucosal involvement, and delayed presentation.
Limitations: This retrospective study had limitations, including polypharmacy in some patients, which limited the accuracy of causality assessment. Rechallenge was not performed due to ethical reasons, which may have affected drug identification.
Conclusion: SCARs contribute significantly to morbidity and mortality. Early diagnosis, prompt withdrawal of the culprit drug, and interdisciplinary management are essential. Patients should be educated about early warning signs, particularly when prescribed antiepileptics and nonsteroidal anti-inflammatory drugs.
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