Drug related toxidermias

Toxidermias are frequently induced by a reaction to medications. They represent between 10 and 25% of hospitalizations due to Adverse Drug Effects and occur more frequently in elderly people that have a lot of medication and in women.

The symptoms can start with a simple rash and lead to critical care in hospital.  Some drugs can trigger the immune system and lead to the necrosis of skin cells, as in a chemical or thermal burn.

Among the most dangerous and deadly forms of TEN:

• Lyell's Syndrome or Toxic epidermal necrolysis (TEN) is the most serious case of severe bullous skin disease. It is often preceded by 1 to 2 weeks of fever and the symptoms may mimic those of a common upper respiratory infection. It starts by a flu-like syndrome. When the rash appears it may be over large and varied parts of the body, and it is usually warm and appears red. The skin then begins to sag from the body and can be peeled off in great swaths. Many non-dermatological damages are associated with it: swollen eyes, respiratory problems, blistered and eroded mouth...
  TEN affects many parts of the body, but it most severely affects the mucous membranes, such as the mouth, eyes, and vagina.
• The Stevens-Johnson syndrome is similar to Lyell's but less than 10% of the surface of the skin peels off and this syndrome may, on rare occasions, be triggered by a virus. You should know that a reaction to a drug may occur after years of use! Although cases may seem rare, do not abuse on anti-inflammatory drugs (like ibuprofen). They induce almost a third of cases of TEN.1

Medicines most commonly to blame:
Antibiotics
Ibuprofen
Allopurinol
Sulfonamides
Paracetamol
Lamotrigine

Testimony of a Lyell/Stevens Johnson syndrome victim

On March 07, 1981, I didn’t feel very well; I’d had an eardrum graft a few weeks before, and the surgeon prescribed me a post-operative treatment. My father collected it from the pharmacy, and the seller told him “it is a strong treatment”. I thought to myself, I am going to take that treatment and all will be ok.

Well no! I began to feel feverish (sensation of flu) and asked my mother to give me an infusion with which I recover from the flu very quickly, because I was rather against the chemical medicines. I took the prescribed medicines because I trusted in the system, and I had read the notice on the medicine that was advised against use for pregnant women. I felt protected.

In the afternoon, I was going for a walk, and I came back more feverish, my mother gave me infusions, and that didn’t make me feel better. In the nights of the 7th to the 8th, and of the 8th to 9th, I couldn’t sleep, my eyes burned, I stood up to splash them with water, that relieved me very little.

March 9, I visited some friends in the morning, but light hurt my eyes, I felt bad in the afternoon, I felt very tired, my throat was burning. In the night, my father called a doctor, who looked at my throat. My parents showed him 5 or 6 times the box of sulfamides, the doctor diagnosed a simple angina, prescribed me some remedies, but I continued to feel worse and worse. The following day, my mother called our family doctor, who prescribed injections of antibiotics.

A few days later, the nurse that makes the injections saw that I was getting worse and worse, and told me: “your eyes and your lips are inflated, you suffer from an allergy.”

My doctor finished by diagnosing the Syndrome of Stevens Johnson. We again showed him the box of sulfamides, and he said: “that is it”. So I stoped the medicine immediately, and recovered some strength. But after 2 days, I was hospitalised exhausted, because I had not eaten or drunk for 8 days. They made me a perfusion, and I felt saved.

It is at the hospital that my eyes began to hurt me. After about 10 days of hospitalisation, I simply left hospital without any advice. After many ophthalmologic procedures, they could only slow down the deterioration of my vision. I lost 80 to 90% of my vision. In 2001, I nevertheless succeeded in closing down the laboratory that manufactures the medicine. E D

For more information: AVIMEDI

• 1. Syndrome de Lyell (La Revue du Praticien, Dermatologie, n°23, 13 octobre 1988)