Preventability of SCARs

Summary Adverse reactions to medicines (drugs) account for 3‐5% of adult hospital admissions and may be fatal. Drugs can cause different types of reactions, and this French team looked at 602 cases of three types of serious skin reactions to drugs, to see what proportion might have been avoided had prescribing been more appropriate. The reactions were Stevens‐Johnson syndrome, toxic epidermal necrolysis (TEN) and ‘drug reaction with eosinophilia and systemic symptoms’ (DRESS). In over half the 602 cases the drug responsible was already well‐known for causing skin reactions: namely, an antibiotic, an anticonvulsant or allopurinol (prescribed to decrease levels of uric acid). The prescription of the responsible drug was deemed inappropriate in 144 (23.9%) of the 602 cases. In 65.8% of the 144 cases it was felt that that drug had not been prescribed for the correct indication (e.g. symptoms) in the first place; in 20.9% the patient had had a reaction to the same drug previously, which had not been taken into account. In the first group the drugs heading the list were allopurinol, mainly prescribed by general practitioners, and the antibiotic co‐trimoxazole, used mainly for uncomplicated urinary tract infections in women; antibiotics, particularly the group known as β‐lactams, topped the list in the second group. A smaller third group consisted of cases where the patient had taken a drug themselves (self‐medication), and here non‐steroidal anti‐inflammatory drugs were the commonest culprits. The authors remind prescribers of the importance of sticking to accepted guidelines, particularly when it comes to prescribing allopurinol and co‐trimoxazole, and of the relevance of a history of a drug‐related skin reaction.