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1,2 Assistant Professor Department of Dermatology Government Medical College Trivandrum, India Corresponding Author Dr Smitha Ancy Varghese Assistant Professor Department of Dermatology Government Medical College Trivandrum, India Abstract Background: Though the system of Ayurveda has traditionally been acclaimed for its safety, questions are being raised by the scientific community regarding the documentation of safety of Ayurveda Medicines. In this article we address cases of severe cutaneous adverse reactions which are possibly related to Ayurvedic drugs. Materials and Methods: A ten year retrospective study was carried out where the case sheets of patients admitted in dermatology ward of a tertiary care centre with cutaneous drug reactions were reviewed. Cases with clinical diagnosis of severe cutaneous adverse reactions (SJS, TEN, DRESS or AGEP) along with history of intake of Ayurvedic drugs were collected. Demographic data, clinical data, drug history and blood investigations were recorded. ALDEN scoring was done to determine causality and SCORTEN score in cases of SJS-TEN cases to assess severity. Results: Seven out of 179 patients (3.9%) who were admitted with SCAR (4 TEN, 2 SJS and 1 DRESS) had a history of taking Ayurvedic drugs with an ALDEN score of 2-3 implying possible causality. Most were in the 30-40 age group. Female to male ratio was 6:1.Hepatic involvement with elevated liver enzymes and hyperbilirubinemia was the commonest systemic association. Severity of disease based on SCORTEN score in patients with SJSTEN ranged from 0-4. All the patients were treated with the withdrawal of the culprit drug and administration of systemic steroids and supportive measures. One patient out of the seven, with extensive TEN expired, thus giving a mortality rate of 14.2% Limitations: Being severe cutaneous drug reactions, drug rechallenge was not done Conclusion: Though rare we may have to consider the potential of Ayurvedic drugs to cause even severe cutaneous adverse reactions. However to ascertain causality and identify culprit agents, collaborative studies with Ayurvedic practitioners are needed.

Severe cutaneous adverse reactions to Ayurvedic drugs: a ten year study from a tertiary care centre in South India