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Improved recognition urged for severe skin reactions to psychotropic drugs
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MIAMI BEACH, Fla. — Adverse cutaneous reactions to psychotropic medications are common, but pediatricians should be aware that sometimes these manifestations can be life-threatening, according to study results presented here during the 2013 American Academy of Dermatology Annual Meeting.
Misha M. Heller, MD, of the department of dermatology at Emory University, and colleagues said physicians must be aware of the clinical presentations of these severe dermatologic manifestations, be able to identify all probable offending agents, and to offer appropriate therapeutic management.
Because psychotropic medications, including mood stabilizers, antidepressants, anxiolytics, antipsychotics and stimulants, are increasingly being prescribed to pediatric and adolescent patients, Heller and colleagues conducted a review of the previously described presentations and recommended management strategies of various types of adverse cutaneous drug reactions.
The researchers searched the PubMed, Medline and Litt’s Drug Eruptions and Reactions Manual databases from January 1966 to October 2011 for articles published in English.
The results indicated that adverse cutaneous reactions to psychotropic medications occur in as many as 5% of patients. The clinical features of common adverse cutaneous reactions included pruritus, exanthematous eruptions, urticaria and angioedema, fixed drug eruptions, photosensitivity, pigmentation, diaphoresis, alopecia, general dermatologic conditions, and serious and life-threatening cutaneous reactions.
General dermatologic conditions that were identified included acneiform eruptions, psoriasiform eruption, seborrheic eruption and lichenoid eruption.
Serious and life-threatening cutaneous reactions were identified as erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis, drug hypersensitivity syndrome, vasculitis, exfoliative dermatitis and anaphylactoid reactions.
For more information:
Heller M. P7140. Presented at: AAD 2013 Annual Meeting; March 1-5, 2013; Miami Beach, Fla.
Disclosure: Heller reports no relevant financial disclosures.
Perspective
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Andrew C. Krakowski, MD
I have three major points to make regarding this study by Heller and colleagues. First, drug reactions are often under-diagnosed and under-recognized, so keep them on the differential diagnosis! Second, any time a drug reaction is suspected, the medical team should do a thorough timeline for when any drugs were started/stopped and when any signs or symptoms developed; this can help identify a culprit medication and help the team make appropriate changes in therapy. This can be done in conjunction with the outpatient or inpatient pharmacy teams. Suspicious reactions should be documented in the patient’ chart.
And, third, while the title of the abstract specifically addresses “cutaneous reactions,” any systemic signs associated with a suspected drug reaction signal a potentially more concerning problem. Therefore, do not hesitate or delay care when a drug reaction is suspected.
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